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HealthCheck

Resources for HealthCheck Providers

The purpose of this HealthCheck resource page is to increase understanding, promote awareness, share resources, and answer FAQs.

Understanding HealthCheck

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) ensures that children and young adults receive early detection and care, so that health problems are prevented or diagnosed and treated as early as possible. Federal law requires state Medicaid programs to provide EPSDT services for Medicaid members under 21 years old.

HealthCheck is the term used for EPSDT in Wisconsin.

The HealthCheck benefit provides periodic, comprehensive health screening exams (also known as “well-child checks”), interperiodic screens, outreach and case management, and additional medically necessary services (referred to as HealthCheck “Other Services”) for members under 21.

Comprehensive HealthCheck screens are age-appropriate medical wellness check-ups that occur on a regular basis. Components of a comprehensive HealthCheck screen include:

  • A comprehensive health and developmental history, including:
    • A health history
    • A nutritional assessment
    • A developmental-behavioral assessment
    • Health education and anticipatory guidance for the member and caregiver
  • A comprehensive unclothed physical exam
  • A hearing screen
  • A vision screen
  • An oral assessment, plus a referral to a dentist beginning when the first tooth erupts or by age 1
  • Appropriate immunizations
  • Appropriate laboratory tests

Wisconsin Medicaid follows the child health screening recommendations and periodicity schedule of the American Academy of Pediatrics (AAP).

Understanding HealthCheck “Other Services”

Wisconsin Medicaid covers most diagnostic and intervention services a member may need. However, federal law requires states to provide additional health care services that are coverable under the federal Medicaid program and are medically necessary to treat, correct, or reduce a member’s illnesses and conditions. HealthCheck “Other Services” is Wisconsin’s term for this federal requirement.

These “other services” include a broad array of interventions, such as physician services, dental care, therapies, home health services, and medical equipment and supplies, which improve the member’s condition, prevent regression, or maintain the member’s status.

Providers can access HealthCheck “Other Services” by following the directions outlined in the Prior Authorization for HealthCheck “Other Services” topic (#1) of the ForwardHealth Online Handbook to submit a prior authorization (PA) request. The following types of PA requests have their own submission requirements:

  • Requests for exceptions to coverage limitations
  • Requests for federally allowable Medicaid services not routinely covered by Wisconsin Medicaid

HealthCheck Resources

The following resources will help you, as a provider, gain a full understanding of HealthCheck and HealthCheck “Other Services.”

Resources for Providers

Resources for County Waiver Agencies (CWAs)

Resources for Providers and CWAs to Distribute to ForwardHealth Members

Physician and Association HealthCheck Toolkit

DHS encourages providers and associations to share any or all information in the HealthCheck Toolkit. For example, newsletter articles can be posted on a website or published within a newsletter, the HealthCheck provider video and/or brochure can be shared on social media, or DHS can be invited to present at an annual conference.

Providers are welcome to contact Provider Services at 800-947-9627 or their field rep for additional HealthCheck information and training. Associations may call Provider Services for more information about HealthCheck, such as having DHS deliver a presentation at an association conference, provide a HealthCheck webinar, or offer group training on HealthCheck.

 
 
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