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EPSDT Maintenance Screen - PM

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Sort services by a EPSDT (early and periodic screening, diagnosis, and treatment) period.

myAvatar PM > Billing > Bill Production > EPSDT Maintenance Screen

  • Information entered in this form will be included for claims sorted by an EPSDT period. Segment SV1, field 11 will be set to 'Y' for services in these claims.

  • This form is enabled through the Enable EPSDT Referral (2300-CRC) registry setting.

  1. In the Select Client screen, enter the client name. Select the client.

  2. If the client has multiple episodes, the Episode Selection pre-display shows. Select the client episode, click OK.

  3. If the client has previous EPSDT records, a screen displays. Select the EPSDT record, click Edit to change information, or click Add to create a new record.

  4. In the Guarantor field, select the guarantor.

  5. In the EPSDT Start Date field, enter the date.

  6. In the EPSDT End Date field, enter the date.

  7. In the Was An EPSDT Referral Given To The Patient (2300-CRC-02) field:

  • Select Yes if the referral was given.

  • Select No if the referral was not give. If No is selected, Not Used is selected in the Condition Code (2300-CRC-02) field.

  1. In the 'Condition Code' fields, select the values for each Condition Code segment.

  2. In the Referring Provider Entity Type Qualifier (2310A-NM1-02) field, enter the qualifier information.

  3. In the 'Referring Provider' demographic fields, enter the provider information.

  4. In the Referring Provider Identification Code Qualifier (2310A-NM1-08) field, enter the qualifier information.

  5. In the Referring Provider Identification Code (2310A-NM1-09) field, enter the code.

  6. In the Referring Provider Reference Identification (2310A-PRV-03) field, enter the identification information.

  7. In the Referring Provider Secondary Reference Identification Qualifier (2310A-REF-01), enter the qualifier information.

  8. In the Referring Provider Secondary Identifier Reference Identification (2310A-REF-02) field, enter the identification information.

  9. Click Submit.

► SQL Tables
  • SYSTEM.billing_epsdt_main_hist
► Dictionary Values
  • Referring Provider Entity Type Qualifier (2310A-NM1-02)
  • Referring Provider Identification Code Qualifier (2310A-NM1-08)
  • Referring Provider Secondary Reference Identification Qualifier (2310A-REF-01)
► Registry Settings
  • 837I-Dates To Populate 2300 DTP
  • Enable EPSDT Referral (2300-CRC)
  • Include Special Program Indicator Code (2300-CLM-12)
  • Use Claim First/Last Dates Of Service
  • Use Coverage Effective/Expiration Dates