____________________________________________________________________________________________EPSDT ToolkitProvider Education _____________________________________________________________________________________________ EPSDT Toolkit Provider Education Plan: Nevada Medicaid Audience: Providers_____________________________________________________________________________________________ INTRODUCTION _____________________________________________________________________________________________The purpose of this toolkit is to provide Nevada Medicaid Managed Care providers with comprehensive guidance on delivering Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services in compliance with federal and state requirements. It reflects contractual expectations outlined by Nevada Medicaid and incorporates references from the Nevada Managed Care Organization (MCO) contract, scope of work (SOW), and state plan. EPSDT is a federally mandated benefit required for Medicaid beneficiaries under age 21. It ensures timely delivery of preventive services and medically necessary care to promote early identification, intervention, and improved health outcomes. EPSDT: THE BASICS _____________________________________________________________________________________________EPSDT is composed of: Early: Identifying and addressing health problems early Periodic: Checking childrens health at regular , age-appropriate intervals Screening: Conducting comprehensive exams including, physical, developmental, vision and hearing Diagnostic: Providing testing and evaluation when a risk or concern is identified Treatment: Delivering all medically necessary services to correct or ameliorate health conditions EPSDT includes coverage for all medically necessary services to correct or ameliorate physical and mental conditions identified through screening, whether or not such services are covered under the Nevad State Plan, as required under federal Medicaid law (42 U.S.C 1396d)). Nevada Medicaid utilizes the Bright Futures/American Academy of Pediatrics (AAP) periodicity schedule as the standard for EPSDT screenings, consistent with CMS guidelines. _____________________________________________________________________________________________ EPSDT IN THE STATE OF NEVADA _____________________________________________________________________________________________ Key Goals of EPSDT in Nevada Prevent illness and detect issues early Reduce long-term complications and healthcare costs Support childrens physical, behavioral, emotional, and developmental health Address comprehensive health needs including mental, emotional, and dental careComponents of an EPSDT Screening Visit As required by Nevada Medicaid, a comprehensive EPSDT screening includes: Unclothed physical exam (unclothed means to the extent necessary to conduct a full, age-appropriate exam) Medical and family history Height, weight, BMI, and head circumference (as applicable) Vision and hearing screening Immunizations per Advisory Committee on Immunization Practices (ACIP) schedule Developmental and behavioral screening (for postpartum caregivers) Lab tests (including lead screening) Oral health and nutritional evaluation Adolescent risk screenings (tobacco, substance use, depression) Health education and anticipatory guidance Comprehensive health and developmental history (including physical and mental health) Blood pressure screening (per age-specific guidelines) Lead screening at age 12 and 24 months and as clinically indicated thereafter Tuberculosis risk assessment and testing as indicated Age-appropriate hearing screening using objective measures per Bright Future periodicity Nevada Periodicity Schedule Providers must follow the Bright Futures/AAP periodicity schedule as adopted and required by Nevada Medicaid. _____________________________________________________________________________________________ EPSDT Screening Timeline Age Well-Child Visit Recommendation Newborn Birth and by 1 month Infant 2,4,6, and 9 months Toddler 12, 15, 18, 24 and 30 months Preschool 3 and 4 years School-aged & adolescents Annually from age 5 to 20 years This table is a high-level summary. Providers must follow the full Bright Futures/AAP periodicity schedule adopted by Nevada Medicaid for complete screening requirements. Care Coordination Responsibilities EPSDT providers are expected to: Mak e referrals to specialists Coordinate with behavioral health, dental, and community support services Share screening results with caregivers Communicate with care managers to ensure follow-up care is provided Track and ensure completion of referrals and follow-up services Note: EPSDT service denials are subject to member appeals per CareSources adverse benefit determination (ABD) process. Follow-Up and Case Management When concerns arise during a screening: Initiate timely referrals for diagnosis or treatment Ensure family understanding of next steps Track and document referral status and outcomes Coordinate with care/case management teams to ensure access and support Documentation & Billing EPSDT providers must: Use correct CPT and ICD codes per Nevada Medicaid guidance Comply with documentation standards for all EPSDT visit elements Retain complete records for each service Document referrals and conditions accurately Use referral indicators and condition codes as required Document all required EPSDT screening components, findings, and follow-up plans _____________________________________________________________________________________________ Refer to the Nevada Medicaid Provider Billing Manual for complete instructions: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20230523.pdf Provider Eligibility Only enrolled and credentialed Medicaid providers may bill for EPSDT services. Providers must: Verify enrollment at: https://dhcfp.nv.gov/uploadedfiles/dhcfpnvgov/content/Public/AdminSupport/PW_03_20_ 18_Presentation_Revised.pdf Confirm credentialing with the applicable MCOs Contact each MCO for specific enrollment/credentialing process questions Referrals & Community Coordination EPSDT responsibilities include: Identifying and referring children to early intervention or developmental services Connecting families with behavioral, dental, and specialty providers Collaborating with local school systems and support programs Ensuring timely access to referred services consistent with Medicaid access standards Dental Services Note: Dental services may be provided by separate vendors but must still be coordinated by the EPSDT provider per periodicity standards. Key Community Resources: Nevada Early Intervention Services (NEIS) Nevada Check-Up Program Behavioral Health providers School-based services and local education agencies Transportation Services Non-emergency Medical Transportation (NEMT) is covered for when medically necessary to access EPSDT services. Providers should: Inform families of this benefit Direct families to their plans transportation broker for assistance A list of transportation vendors is available via the Nevada Medicaid site. _____________________________________________________________________________________________ PROVIDER SUPPORT _____________________________________________________________________________________________ Provider Outreach & Support Nevada MCOs will support EPSDT performance through: Outreach and appointment reminder campaigns Member education initiatives Collaborating to close gaps in care Providing culturally appropriate patient materials Support Contact s Providers can contact: The CareSource Provider Services Department at: 937-224-3300 Assigned Provider Engagement Representative: reach out using CareSources Prov ider Relations contact list or via the portal account Nevada Medicaid Provider Services-General Support Line: 877-638-3472-Reno Office: 775-684-3700-Enrollment & Resources: https://www.medicaid.nv.gov/providers/enroll RESOURCES _____________________________________________________________________________________________Direct Links & Billing Tools for Nevada EPSDT Providers Nevada Medicaid EPSDT Overview https://adsd.nv.gov/uploadedfiles/adsdnvgov/content/Boards/Autism/RuralAdult/Medicaid101.pd f EPSDT Periodicity Schedule (Bright Futures , Adopted by Nevada Medicaid) https://www.aap.org/en/practice-management/care-delivery-approaches/periodicity-schedule/ Non-Emergency Medical Transportation (NEMT) Vendor MTM Nevada https://www.mtm-inc.net/nevada/ Early Intervention Services https://dhhs.nv.gov/Programs/IDEA/Early_Intervention_Programs/ _____________________________________________________________________________________________ School-Based Health Centers in Nevada https://dpbh.nv.gov/uploadedFiles/dpbh.nv.gov/content/Programs/AH-Comp/SBHC%20Toolkit_Appendices%20FINAL(1).pdf Billing & Coding Reminders for Nevada EPSDT Providers EPSDT-related claims must: Include referral/condition codes when applicable: – AV Available, Not Used-ST Scheduled Test-S2 Under Care of Another Provider-NU Not Used Enter these in: – Field 24h on paper claims-Loop 2300 CRC segment for EDI (electronic claims) Use EPSDT modifier EP to denote screening services when required per Nevada Medicaid billing guidelines. Use modifier TS to indicate that a referral or follow-up is indicated. – When using modifier TS, be sure to complete field 21 on the CMS-1500 claim form with the appropriate diagnosis code to reflect the condition requiring follow up. Refer to the Nevada Medicaid Provider Billing Manual for complete EPSDT claim submission guidance. Internal Support Materials For internal documentation workflows, approved EPSDT screening templates, or procedural guidance: Contact your CareSource Provider Engagement Specialist Log into the CareSource Nevada Provider Portal at: https://www.caresource.com/nv/providers/ _____________________________________________________________________________________________ Additional Nevada Resources Nevada Medicaid EPSDT Program Overview https://dhcfp.nv.gov/pgms/cpt/epsdt/ Bright Futures Guidelines (AAP) https://www.aap.org/en/practice-management/bright-futures/bright-futures-materials-and-tools/bright-futures-guidelines-and-pocket-guide/ Nevada Medicaid Provider Enrollment Portal https://flex.medicaid.nv.gov/a/3b8917dc-5086-49c9-8e1b-8c748320d7fd/t/0de061ea-dc68-4cb8-b6c3-e7fb7e8cb2c1/v Nevada Medicaid Provider Billing Manual https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20230523.pdf MCO Provider Engagement Representatives NV-MED-P -5453100
Save the Date ! Friday , Ju ly 31, 20 26 12:00 p.m. to 2:00 p.m. Eastern Time (ET)/11:00 a.m. to 1:00 p.m. Central Time (CT) You are invited to the Quarterly Friday ForumProvider Friday Forum Register for the Event here Agenda: CareSour ce July 2026 Fri day ForumTime Topic12:00 p.m. 12:03 p.m. ET /11:00 a.m. 11:03 a.m. CT Member Enrollment Demographics Snapshot 12:03 p.m. 1:30 p.m. ET /11:03 a.m. 12:30 p.m. CT Comprehensive Overview of Dental Enrollment, Claims 1:30 p.m. 2:00 p.m. ET /12:30 p.m. 1:00 p.m. CT Updates and Announcements Please provide your Provider Engagement Specialist with any topics, discussions, or questions you would like to see highlighted within this presentation. An official invitation will follow. We look forward to your attendance! IN-Multi-P-2903317-V.1; Issued Date: 06/03/2024 OMPP Approved: 06/03/2024 .
SPRING 2026PROVIDER Source A Newsletter for TRICARE Prime Demo by CareSource Military and Veterans TM Network ProvidersIN THIS ISSUE: 2 Which TRICARE? A Quick Question That Prevents Delays3 Chief Medical Officers Note3 TRICARE Prime Demo at a Glance3 Working with Us: Quick Start4 Onboarding & Provider Survey At CareSource Military & Veterans (CSMV), we support TRICARE Prime Demo network providers with clear guidance, practical tools and timely updates that help you deliver covered care to our shared beneficiaries.ProviderSource is a quarterly newsletter for TRICARE Prime Demo network providers in Florida and Georgia, covering: Tools, online resources and trainingProgram updates and process/policy r emindersClinical resources and practice guidanceThank you for your partnership in caring for active-duty family members, r etirees and their families, families of activated guard & reserve, and survivors enrolled in the TRICARE Prime Demo.Which TRICARE? A Quick Question That Prevents DelaysWhen a beneficiary says they have TRICARE, please ask:Which TRICARE? CareSource Military and Veteran (CSMV) or TRICARE East-Humana?If the beneficiary is enrolled with:TRICARE Prime Demo by CareSource Military & Veterans follow the TRICARE Prime Demo pr ocesses. Use the TRICARE Prime Demo Provider Portal and CareSourceMilitary.com.Another TRICARE contractor (such as TRICARE East-Humana) follow that contractor s processes, portals and contact information.This simple question up front helps:Confirm the correct TRICARE contractor.Avoid eligibility and billing issues.Support timely access to care for our TRICARE Prime Demo beneficiaries. 2PROVIDER S | Spring 2026 3 Important Updates / Your Practice Chief Medical Officers Note I am pleased to extend a warm welcome to you, our TRICARE network partner in providing quality health care. As the Chief Medical Officer (CMO) for TRICARE Prime Demo by CareSource Military & Veterans TM (CSMV), I am committed to getting the fundamentals rightstrengthening claims payment accuracy and efficiency while reducing the day to day administrative burden in your interactions with CSMV.As a practicing physician, I respect the demands on your time. Our focus is simple: timely prior authorization decisions, accurate and efficient claims pr ocessing and easy-to-use self-service toolsso it is straightforward and predictable to do business with CSMV.CSMVs mission is to improve the health and well-being of those we serve, with care coor dination and support designed for the military community.Sincerely,Dr. Weston Chief Medical Officer TRICARE Prime Demo by CareSource Military & Veterans TM TRICARE Prime Demo at a Glance If you are new to TRICARE Prime Demo, start here: Use the Provider Portal, ProviderPortal.CareSource.com for eligibility, prior authorization, claim status and other self-service tools.Reference the Provider Manual and Quick Refer ence materials on CareSourceMilitary.com for detailed requirements.Call Provider Services at 1-833-230-2170 if you need help resolving an issue.Working with Us:Quick Start Use the options below for the fastest way to confirm eligibility, submit requests and resolve claims or administrative questions.Provider Services: 1-833-230-2170 (Monday thr ough Friday, 8 a.m. to 6 p.m. Eastern Time (ET)EDI Payer ID: MVCS1Provider Portal: ProviderPortal.CareSource.comProvider Manual, Forms, FAQs and Updates: CareSourceMilitary.com > ProvidersTraining: CareSourceMilitary.com > Education > T raining & Events (plus HealthPlanResources.com) For more information, visit CareSourceMilitary.com P.O. Box 8738 Dayton, OH 45401-8738 VISIT USCareSourceMilitary.comJOIN US Facebook.com/CSMilitaryX.com/CS_MilitaryInstagram.com/CareSourceMilitary Onboarding & Provider Survey New to TRICARE Prime Demo by CareSource Military & Veterans? Scan the QR code to complete onboarding and share feedback so we can improve tools, communications and day to day support. Thank you for your continued partnership and for the care you provide to our nations service members, their families and retirees.Multi-TRICARE-P-53484032026 CareSource Military & Veterans. All Rights Reserved.TRICARE is administered in Tampa, Florida, and Atlanta, Georgia, by CareSource Military & Veterans , under contract with the Department of Defense. TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.
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