Forms
View frequently asked questions
| Overview | Forms | Training | CMS 416 Reports | EPSDT Resources | Help |
|---|
- EPSDT Fillable PDF
- EPSDT Online
Access the NEW fillable EPSDT 8015/8016 fillable ePDF. Click on the PDF icon to download the fillable ePDF. --------------------------------------------->
- CLICK HERE to download the instructions for the 8015
- CLICK HERE to download the instructions for the 8016.
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.
Once you click to download, you will need to select to open the file in your "Open with system viewer" located on the bottom left of your browser.
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 the 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.
