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Access the NEW fillable EPSDT 8015/8016 fillable ePDF. Click on the PDF icon to download the fillable ePDF. --------------------------------------------->
You will need the Adobe Acrobat Reader or Adobe Acrobat to open and complete the form. To access Adobe Acrobat, click here.
If printing forms, BOTH pages of the 8015 or 8016 must be printed and mailed with the CMS 1500 attached.
How do I get enrolled to submit EPSDT data online?
Providers will need to initiate a clinic getting enrolled into EPSDT Online.
What do I need to do?
All providers will need to follow the steps below:
What if I have trouble setting up an account or onboarding to EPSDT Online?
If you have any questions or run into problems as you are onboarding, contact the EPSDT Helpdesk at:
(808) 900-8650 or email at [email protected]
How do I add my staff on EPSDT Online?
A provider must be the first one to initiate onboarding to EPSDT Online. This can be ANY Hawaii Medicaid enrolled Provider who’s HOKU application is associated to the clinic billing entity ID in HOKU. Once an individual provider is enrolled, all billing providers they are associated with on their HOKU application will automatically populate in EPSDT Online. To begin enrolling staff, the provider will need to indicate the billing entity that they would like to add staff to on EPSDT Online. All providers can add new provider support staff to EPSDT Online.
Can I assign a staff member to onboard the clinic staff?
Yes! EPSDT Online has a Business Manager role clinics can assign to help manage onboarding provider support or end dating any clinic user if they are no longer working with the clinic. To protect patient health information, the Business Manager only has access to onboard and offboard clinic users and does not have access to EPSDT records. All staff who need to input PHI in EPSDT online will need to be enrolled as Provider Support. If the Business Manager also needs to see patient records, they will need a separate login associated to a separate email address for a provider support login. Please note that Business Managers can only enroll provider support. They cannot enroll providers. All providers will need to follow the steps above.