Forms
View frequently asked questions
| Overview | Forms | Training | CMS 416 Reports | EPSDT Resources | Help |
|---|
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit is a federally mandated benefit under Title XIX of the Social Security Act. This benefit provides preventive and comprehensive health services for Medicaid-eligible individuals under age 21. The EPSDT benefit is provided to Medicaid-eligible infants, youth and participants up to the age of 21. The primary goal is to offer prevention, early diagnosis and medically necessary treatment of conditions.
As of January 1, 2022, the EPSDT process has been modernized. Now, EPSDT providers can go paperless! Sign up to be an Early Adopter to submit EPSDT visit data online.
Sign up for the Early Adopters Program
Want to submit EPSDT visit data online?
Join the Early Adopter Program to begin streamlining your EPSDT visit data submissions and expedite health plan processing of your forms and claims.
What do I need to do?
Med-QUEST is enrolling providers and their support staff under the billing provider NPI. This way your team can be associated in the portal. Association in the portal will enable your team to have support staff prepare forms, send to the provider, and allow the providers to receive, review and submit EPSDT visit data online!
Click here for User Profile Request
When signing up list all providers and support staff who help prepare forms or claims for EPSDT visits and email to [email protected] Each user must have a unique email indicated on the request. Please note, billing providers and rendering providers will need to have submitted applications in HOKU, the web-based Medicaid Provider Enrollment system prior to being onboarded to EPSDT Online.
The new process offers three (3) ways for EPSDT providers to submit EPSDT visit data.
Online
Login, complete, and submit the visit data through the new EPSDT online.
Fillable PDF
Access the DHS 8015/8016 fillable PDF online, fill using your electronic device, and submit online.
Print and Mail
Access the DHS 8015/8016 fillable PDF online, fill using your electronic device, print both pages, attach to the CMS 1500 and mail.
The DHS 8015 and 8016 have been converted to one (1) fillable PDF.
The DHS 8015 is used to submit comprehensive EPSDT visit data and the DHS 8016 is used to submit follow-up EPSDT visit data.
If printing forms, BOTH pages of the 8015 or 8016 must be printed and mailed with the CMS 1500 attached.
