The Pennsylvania Department of Human Services (DHS) states that all children enrolled in Pennsylvania's Children's Health Insurance Program (CHIP) should receive testing for elevated blood lead levels (EBLL) and developmental screening as recommended below.
Lead testing and developmental screening recommendations
Practitioners are encouraged to follow the DHS Medicaid and Bright FuturesTM guidelines for lead testing and developmental screening. A lead blood test should be completed at ages 9 to 12 months and again by age 24 months. Formal screening for developmental disorders using a standardized tool, such as the Ages and Stages questionnaire (CPT® 96110), should be completed for children who turn 1, 2, or 3 years of age or when surveillance yields concern. The screening should be documented in the patient’s chart and included in a claim.
Screening and documentation are especially important for children enrolled in CHIP because of the higher incidence of developmental delay among certain pediatric populations enrolled in government-sponsored programs when compared to children enrolled in privately insured plans.
CHIP members should meet the DHS guidelines for lead testing and developmental screening regardless of risk level. We know many provider practices have already performed these tests, and we thank you and your staff for the care you provide to our pediatric and CHIP members.
Additional well visits
Children who turn 15 months old during the measurement year should receive six or more well-child visits. Children ages 3 to 6 should have one or more well-child visit with their physician each year.
What your practice can do
To help ensure your members receive the required testing, your practice can do the following:
- Screen children for EBLL by performing a risk assessment at 6 months, 9 months, 18 months, and then annually
from ages 3 – 6, with testing as appropriate.
- Perform developmental surveillance at each well-child visit and document the use of a standardized developmental screening tool for children who turn 1, 2, or 3 years of age or when surveillance yields concern. Examples of validated screening tools for developmental delays can be found on the Bright Futures website:
- Discuss recommendations for lead testing and developmental screening with the parents/guardians of your CHIP patients.
Identifying CHIP members
To help your practice easily identify CHIP members, we include the identifying words “PA Kids” on the front of Independence ID cards, as shown in the sample CHIP ID card below.
Reminder: PROMISeTM ID required to render services to CHIP members
The state of Pennsylvania requires a Provider Reimbursement and Operations Management Information System (PROMISe) ID for all providers who render, order, prescribe, or bill for items or services to CHIP members. There are a few important things about PROMISe IDs to keep in mind:
- DHS implemented the Affordable Care Act provision that requires all providers who render, order, prescribe, or bill for items or services to CHIP members be registered with DHS as a CHIP provider at each provider location.
- Upon acceptance, DHS will issue providers a PROMISe identification number for
- Remember, obtaining a PROMISe ID does not mean providers must accept Medical Assistance beneficiaries.
As of July 1, 2019, a PROMISe ID is required for providers to receive payment from Independence for services or items rendered, ordered, prescribed, or billed for CHIP members.
As of July 1, 2019, claims submitted to Keystone Health Plan East by a provider who does not have a PROMISe ID at the location where services or items were rendered, ordered, prescribed, or billed for CHIP members will not receive payment.
- Visit the DHS
website to access the application, requirements, and step-by-step instructions related to the enrollment process.
The following resources provide additional information regarding lead testing and developmental screening recommendations:
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