Health Tracks for Providers

Many children with developmental delays or behavior concerns are not identified as early as possible. As a result, these children must wait to get the help they need to do well in social and educational settings (for example, in school, at home, and in the community).

In the United States, about 1 in 6 children aged 3 to 17 years have one or more developmental or behavioral disabilities, such as autism, a learning disorder, or attention-deficit/hyperactivity disorder. In addition, many children have delays in language or other areas that can affect how well they do in school. However, many children with developmental disabilities are not identified until they are in school, by which time significant delays might have occurred and opportunities for treatment might have been missed.

At selected visits, Bright Futures recommends universal screening for developmental concerns, behavioral/social/emotional concerns, adolescent depression and suicide risk, or substance use. A number of screening tools have been developed and are commonly used. For more information refer to the “Instruments for Recommended Universal Screening at Specific Bright Futures Visits” Bright Futures Toolkit: Links to Commonly Used Screening Instruments and Tools

Links to some commonly used tools:

• Ages & Stages Questionnaire – Third Edition (ASQ-3)
• Ages & Stages: Social-Emotional 2nd Edition (ASQ:SE-2) 
• Baby Pediatric Symptoms Checklist (BBSC)
• Modified Checklist for Autism in Toddlers (MCHAT)
• Patient Health Questionnaire (PHQ -2, PHQ-9, or PHQ-A) 
• Pediatric Symptom Checklist (PSC, PSC-Y or PSC-17)
• Preschool Pediatric Symptoms Checklist (PPSC)
• Screening to Brief Intervention (S2B1)
• Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT)
• Brief Screener for Alcohol, Tobacco and other Drugs (BSTAD)

Please visit the Health Tracks and EPSDT Policy for more information

All screening tools are expected to be evidence-based.

The Center for Disease Control and Prevention (CDC) estimates that almost 20 percent of women will experience some type of depressive episode during or after pregnancy. Studies reveal that postpartum depression leads to increased costs of medical care, inappropriate medical treatment of the infant, discontinuation of breastfeeding, family dysfunction, and an increased risk of abuse and neglect. Maternal depression screening is covered when performed in conjunction with a well-child visit for an infant.

The AAP recommends pediatric medical homes integrate postpartum depression surveillance and screening at the 1-, 2-, 4-, and 6-month well-child visits and use community resources for the further assessment and treatment of the mother with depression.

Recommended maternal depression screening tools:

• Edinburgh Postnatal Depression Scale (EPDS)
• Patient Health Questionnaire - 9 (PHQ-9) Screener

Please visit ND Medicaid Provider Manual and Guidelines under Health Tracks-EPSDT for more information.

Protecting children from exposure to lead is important for lifelong good health. Even low levels of lead in blood have been shown to affect IQ, ability to pay attention, and academic achievement. There are often no apparent symptoms when a child is exposed to lead. Because of this, a blood test is the best way to determine if a child has been exposed to lead.

The Centers for Medicare and Medicaid Services require all children enrolled in Medicaid to get tested for lead at ages 12 and 24 months. Children eligible for Medicaid between the ages of 36 months and 72 months of age must have a blood lead test completed if they have not been previously screened for lead exposure.

CDC recommends health care providers use either a capillary or venous sample for the initial blood lead level. If the capillary results are equal to or greater than 3.5 ug/dl, a venous sample should be collected. Recommended Actions Based on Blood Lead Levels | Lead | CDC

All blood lead level results are included in the mandatory reportable conditions per ND Administrative code 33-06-01-01 Reportable Conditions. The lead toxicity screening questionnaire (SFN 59322) can be utilized for children screened at ages outside the ranges noted above.

Please visit the AAP Lead Exposure Policy for current recommendations for providers.

Dental caries remains the most common chronic preventable childhood disease in the United States. The use of fluoride varnish is an effective way to prevent and, in some cases, stop dental decay. Fluoride varnish is a thin coating of sodium fluoride (5%) that’s placed on the surface of a child’s teeth. The coating forms a sticky layer that hardens when it comes into contact with saliva. The fluoride is then absorbed into the enamel of the teeth. According to the Federal Food and Drug Administration, fluoride varnish is categorized as a drug that presents minimal risk to the patient.

www.cdc.gov/nchs/products/databriefs/db307.htm - source

• North Dakota Medicaid covers fluoride varnish for members ages 0 through 20 years
• Fluoride varnish is most effective when started in infancy before dental caries develop
• Fluoride varnish application is recommended at the time of a Health Tracks screening/well-child visit
• An oral health assessment should be performed at every Health Tracks screening/well-child visit
• Early prevention and promotion activities begin by ensuring each child or adolescent has a dental home
• Oral health is an important component of child and adolescent development.

Please visit Coding Guideline for Fluoride Varnish for more information.

Links to Oral Health and Fluoride Varnish Resources:

• North Dakota Provider Manual for Dental Services
• Smiles for Life ND Board of Dental Examiners Approved Fluoride Varnish Training & Resources
• Benefits of Fluoride Varnish FAQ
• FV Information for Providers
• Patient Guardian FV Handout - English Version
• Patient Guardian FV Handout - Spanish Version
• North Dakota Oral Health Program
• AAP Oral Health Practice Tools
• BF_OralHealth_Tipsheet.pdf (aap.org)
• Nutrition and Oral Health (ada.org)

Orthodontia treatment under ND Medicaid includes the following treatment options:

• Cleft lip or cleft palate – immediate referral
• Limited Orthodontia Treatment – early treatment of developing malocclusions, ages 7 to 10
• Comprehensive Orthodontia Treatment – improvement of craniofacial dysfunction and /or dentofacial abnormalities, ages 10 through 20

An Orthodontia Screening needs to be completed and meet established criteria prior to being referred to an orthodontist for further assessment. These screenings can be completed at participating local public health units and dental offices. Members can contact the Health Tracks Member Outreach team at 701-328-2014 (press 1) or htmemberoutreach@nd.gov to find a screening provider in their community.

In-person Health Tracks Orthodontia Trainings are offered as needed. Online Orthodontia training is available through ND Train Course ID #: 1101233. For additional instructions on accessing this training or if your practice is interested in providing this service, please contact the Health Tracks Provider Outreach team at 701-328-2014 (press 2) or htprovideroutreach@nd.gov

See Orthodontic Screening Guide for North Dakota Health Tracks Nurses for screening guidelines and instruction on completing Health Tracks Comprehensive Orthodontic Screening form.

See Policy for Health Tracks Orthodontia Screening for billing and coding information.

Health Tracks Orthodontia Screening Handout for Parents

The AAP strongly recommends on-time routine immunization of all children and adolescents according to the Recommended Immunization Schedules for Children and Adolescents.

Immunizations are one of the greatest public health achievements, preventing tens of thousands of deaths, millions of cases of disease, and saving billions of dollars per decade. Immunizations are a safe, effective way to protect children from disease, including some cancers, as well as hospitalization, disability, and death.

Medical providers play a crucial role in immunizing children and are a trusted source for vaccine information. Vaccine conversations with parents should begin as early as possible.

Immunizations (aap.org) source 

North Dakota Medicaid covers immunizations for children and adults that are medically necessary and approved by the Federal Drug Administration (FDA). ND Medicaid also covers immunization administrations when the vaccine/toxoid is supplied by another entity.

General Information for Providers Manual – Immunization Section

Links to Immunization Resources:

• CDC Immunization Schedules
• VFC – Vaccines for Children Program

• Immunizations | Health and Human Services North Dakota

   

Less than half the of the children who have access to services through ND Medicaid’s Health Tracks/Well-Child Check benefit receive the critical preventive services that can help them get a healthy start in life and maintain their health as they grow into adults.  

Preventive care offers you the greatest opportunity to maximize your reimbursements as well-visit claims often reimburse you at a higher rate than sick visits. Following are a few ideas that may work for you to increase and to avoid missed opportunities for Health Tracks/Well-Child visits within your practice. 

Staying on Schedule

Individuals under the age of 20 who qualify for ND Medicaid’s Health Tracks/Well-Child Check benefit are eligible for well care visits on the same schedule recommended by Bright Futures the Academy of Pediatrics (AAP). Each interval on the schedule serves as a key health checkpoint for a child, as well as a reimbursement opportunity for you. ND Medicaid does not limit the number of check-ups a child receives per year.   

Pre-Schedule Newborn Checkups

Scheduling a years’ worth of checkups for a newborn can give parents a plan to follow for their child. For the babies, it helps keep a path of care in place even if they miss a well-care visit.  

Combining a Health Tracks/Well-Child Visit with other Types of Visits

Many kids go several years between checkups - especially if your patient is a teenager. Because an office visit for an illness, immunizations, prescription refill or other reason may be the only chance you have to conduct a Health Tracks/Well-Child check, Medicaid guidelines allow reimbursement for both a “sick” and “well” visit on the same day. To learn more about combining sick and well visits review Provider Guidelines, Manuals, and Policies under the Health Tracks-EPSDT section. 

Converting a Sports Physical to a Well-Care Visit

When a family calls into your office for a sports physical, encourage the family to schedule a Well-Child visit, not only would a family benefit by having preventative services and meet all requirements of the sports physical. 

To find information including the sports physical form for North Dakota High School Activities Association Forms visit their website.

We now cover sports physicals! If a parent only wants a sports physical, providers may utilize the Sports Physical CPT© code 99429 along with the ICD-10 code Z02.5

Download: ND Medicaid Health Tracks/Well-Child Sports Physical Poster English version

Converting an Immunization Only or Orthodontic Screening Only visit to a Health Tracks Screening/Well-Child Visit

When a family schedules an appointment specifically for immunizations only or an Orthodontic screening only. This is an opportunity for staff to encourage converting the appointment to a Health Tracks/Well-Child visit to ensure the child receives needed preventive services. 
 

Alternate and Extended Office Hours

Many times, parents and others caring for children have jobs that don’t allow them to bring their kids in for visits during normal office hours. Some practices have found offering appointment times earlier in the morning, later in the evening or on weekends helps ensure more kids get preventive care. 

Electronic Medical/Health Records (EMR/EHR)

Most of the EMR/EHR systems available have tools to help manage and schedule patient visits. Some practices are using automatic reminders to help see more patients and reduce missed visits. Others are tracking when patients are overdue for checkups or health screenings and contacting them with phone calls or letters.
 

Staff Dedicated to Checkups

Assigning staff specifically to manage checkups can make the process of closing Health Tracks/Well-Child visit gaps more efficient. Staff dedicated to checking records, contacting, and scheduling patients who are overdue for checkups, as well as staff that identifies potential appointments that can be combined into a Health Tracks/well-child visit.  

Any member who has not had the recommended services should be brought up to date as soon as possible. Subsequent visits should be scheduled based on the recommended guidelines. Consult the Bright Futures Well Child Periodicity Schedule for details of age-appropriate visits at periodicity_schedule.pdf (aap.org).  

Abnormal Findings

It is recommended that a patient’s medical home provider be notified of any abnormal medical finding. A warm handoff between providers in a referral relationship reinforces the patient’s trust in our judgement, helps build the patient’s relationship with the referral provider and sets the stage for more effective care.  

The American Academy of Pediatrics (AAP) recommends that healthcare provider

• Monitor the child’s development during regular well-child visits 
• Periodically screen children with validated tools at recommended ages to identify any areas of concern that may require a further examination or evaluation 
• Ensure that more comprehensive developmental evaluations are completed if risks are identified  
   

Covered Services:

Vision, hearing, and dental screenings are considered part of the Health Tracks screening/Well-Child check and cannot be billed separately. The following may be billed separately using the appropriate CPT code:

• Immunizations and administration
• Fluoride Varnish
• Developmental Screenings and Brief Behavioral Assessments
• Maternal Depression Screenings
• Laboratory tests, and
• Other necessary diagnostic and treatment services

Well-visit claims reimburse you at a higher rate than sick visits, and we count well-child checks in the ND federal EPSDT report to Centers for Medicare and Medicaid Services (CMS)

ND Medicaid will cover inter-periodic Health Tracks/Well-Child visits as often as considered medically necessary by a provider, so long as it is billed as a Health Tracks/Well-Child visit only. 

Please refer to ND Medicaid Provider Fee Schedules for the most current rate and fee schedules

Coding for Pediatric Preventive Care 2022 (aap.org)

Limitations:

ND Medicaid will not reimburse Healthcare Common Procedure Coding System (HCPCS) code S0302 – EPSDT screening and Current Procedural Terminology (CPT) code 9938x/9939x – Preventive Medicine Services on the same date of service.

Checking MA Eligibility

It is the provider’s responsibility to check MA eligibility and recipient liability (RL) prior to each visit. It is recommended to check eligibility within the month of the scheduled visit. Eligibility and RL can be verified through North Dakota’s Medicaid Management Information System (MMIS) or by calling North Dakota

Medicaid’s Automated Voice Response System (AVRS) (available 24/7) at 877-328-7098 or 701-328-7098.

Please see the North Dakota Medicaid Provider Manual - Under the Provider Information Section 

Disclaimer: Remember to follow your agency’s HIPAA’s policy before conducting outreach

The HT Provider Outreach team is here to help you develop customized outreach strategies that works best for your patients and practice. The HT Provider Outreach team can be reached at 701-328-2014 (press 2) or htprovideroutreach@nd.gov.

Outreach Lists

For providers who provide Health Track screenings/Well Child Checks in a public health setting we will provide you with a monthly outreach list which will identify members who have been notified they are due for a Health Tracks screening/Well Child Check. You can utilize these resources to help increase preventive care in your office. 

Inviting Your Patients to the Office

For Local Public Health Agencies who provide Health Track screenings/Well Child Checks, we are able to provide you with a monthly outreach list which will identify members who have been notified they are due for a Health Tracks screening/Well Child Check. You can utilize these resources to help increase preventive care in your office.

These reports will be made available each month upon request by identifying your agency’s business need and contacting htprovideroutreach@nd.gov. (Example: We would like to request the monthly outreach list and this month we will be using the data to...)

Below are links to flyers and posters and script examples you can use when conducting outreach.

ND Medicaid Health Tracks/Well-Child Check Flyer (Customizable)  

Health Tracks/Well-Child Checks

Download:  ND Medicaid Health Tracks/Well-Child Check Flyer (Customizable) - English version 
Download:  ND Medicaid Health Tracks/Well-Child Check Flyer (Customizable) - Spanish version  

ND Medicaid Health Tracks/Well-Child Check Poster  

Coverage is Stylish

Download: ND Medicaid Health Tracks/Well-Child Check Poster - English version 
Download: ND Medicaid Health Tracks/Well-Child Check Poster - Spanish version 

Regular initial outreach:

If answer:

Hi, this is <NAME> with <PRACTICE NAME>. Are you

<CHILD’s NAME> parent or guardian?

I’m calling because our records show that <CHILD’s NAME> needs a checkup. I can make an appointment for your child to see their doctor.

May I schedule your child’s visit?

If no answer:

Hi, this is <NAME> with <PRACTICE NAME>.

I’m calling because our records show that your child(ren) needs a checkup. I can assist you to make this/these appointment(s) to see their doctor(s). We’d like to get your child(ren) scheduled as soon as possible. Please call us back at <PHONE NUMBER>.

Reminder call for families who’ve already scheduled:

Hi, this is <NAME> with <PRACTICE NAME>.

Are you <CHILD’s NAME> parent or guardian?

I’m calling to remind you that your child(ren) has an appointment with <PROVIDER’S NAME> at <TIME> on <DATE> at <PROVIDER LOCATION/ADDRESS>. We look forward to seeing you then.

Outreach Text Message:

Our records indicate your child(ren) is due for a health tracks/well-child checkup. Please call <PHONE NUMBER> to make an appointment with <PROVIDER’S NAME>.

Reminder Text Message:

As a reminder your appointment with <PROVIDER NAME> is scheduled at <TIME> on <DATE> at <PRACTICE LOCATION/ADDRESS>

Gap in Care Report (Coming Soon)

Practices who have chosen to partner with Health Tracks will receive a Gap-in-Care report. This report will be emailed quarterly to the clinical contact(s) identified by each practice. The purpose of this report is to assist providers with identifying members who may be missing their Health Tracks/Well-Child visit and to ensure our members have access to quality healthcare. This report is created by pulling data from our claims system, Medicaid Management Information System (MMIS) and shows members who are either coming due or are past due for their recommended Health Tracks/Well-Child visit.

Suggestions for working the report:

• Due to the time lag between claims and real time, it will be helpful to reconcile the report with your EMR or paper chart to see if the HT/WC visit has already been completed.
• If the member has not had a recent HT/WC visit, we encourage practices to call the member/family to set up an appointment.
• If a member on the report is not in your system, they are newly assigned to your practice, either by their choice or auto assigned through ND Medicaid.

MMIS Outreach Lists

The MMIS Outreach Lists will be made available monthly to local public health units who offer Health Tracks screenings and outreach services. This list includes members who recently received a Health Tracks/Well-Child Child Check notice informing them they are due or past due for a Health Tracks/Well Child Check based on the Bright Futures periodicity schedule.

Suggestions for working the report:

• EPSDT Notice Type (last column) N = New Member AM = Annual Notice PD= Past Due (only sent in April and October)
• If you would like to focus your outreach efforts on a specific notice type first (i.e. those due for their annual visit) you can filter the list; click on Sort & Filter, choose filter, click on down arrow in the EPSDT Notice Type Column, select AM only, to see only the members who received an annual notice.
• If you would like to see all members under a case number (typically household) that received a notice, you can sort the list by case number; click on Sort & Filter>custom Sort> Case Number in the Sort by dropdown box>cell values in Sort On > A to Z in Order>OK.
• New Members receive a “Welcome to Medicaid” phone call or letter from the Health Tracks Member Outreach team. At the end of each month, they will send you information on any members who have indicated that that they would like to receive their HT/WC visit by your agency.

If you are not receiving these reports and would like to, please contact Health Track Provider Outreach team at HTprovideroutreach@nd.gov or call (701) 328-2014, (press 2).

North Dakota's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Benefit Report

Who can conduct EPSDT screenings?

Any qualified provider operating within the scope of his or her practice, as defined by state law, can conduct a Health Tracks/Well-Child check. However, there are some exceptions and practices are encouraged to follow their agency standards and Medicaid Program Provider Agreement.

Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) - Please see your section within the Medicaid Provider Guidelines, Manuals, Policies.

Do members receive reminders encouraging them to seek Health Tracks/Well-Child services? If so, how often?

• Members are mailed notices based on the AAP Periodicity Schedule encouraging them to schedule a Health Tracks/Well-Child visit.
• If we have no record of a member receiving a Health Tracks/Well-Child visit within the recommended screening time frame, the member will be mailed a past due notice in April and October.
• If our records indicate that a member has not received a dental examination in the past 6 months, they are mailed a Dental notice encouraging them to schedule a dental examination.

What if one of my patients has questions about Medicaid member eligibility, denials, or other claim issues?

Members may reach out to the following:  
•    For assistance questions - customer support call center Toll-free at (866)-614-6005  
•    TTY: 711 
•    They can email their request(s) to applyforhelp@nd.gov

Hours for key contacts are 8:00 a.m. to 5:00 p.m. Monday through Friday (Central Time)

What if I as a provider have questions about member eligibility, denials, or other claim issues

• Please reach out to the ND Medicaid provider call center Toll-free at (877) 328-7098 or you may email inquiries to mmisinfo@nd.gov
• For eligibility related questions - Customer Support Center Toll-free at (866) 614-6005

Hours for key contacts are 8:00 a.m. to 5:00 p.m. Monday through Friday (Central Time)

Can my practice have access to the Bright Futures forms?

• The Bright Futures Tool and Resource Kit, 2nd Edition (aap.org) is available as an online access product and can be purchased through the American Academy of Pediatrics.
• Local Public Health Units can access Bright Futures by contacting Kimberly Hruby at 701-328-4854 or krhruby@nd.gov for log-in information.

Can a blood lead screening be completed prior to 12 months or after 24 months?

• The Centers for Medicare and Medicaid Services require all children enrolled in Medicaid to get tested for lead at ages 12 and 24 months. Children eligible for Medicaid between the ages of 36 months and 72 months of age must have a blood lead test completed if they have not been previously screened for lead exposure.
• As always, guidelines are recommendations, but it remains at the discretion and judgement of the provider to determine risk and the appropriate course of action. The lead toxicity screening questionnaire (SFN 59322) can be utilized for children screened at ages outside the ranges noted above.

If a child comes in for a sick visit, but EPSDT services were also provided, can an EPSDT well-care claim and sick-child claim be submitted for the same day?

Yes, Medicaid guidelines allow reimbursement for both a “sick” and “well” visit on the same day. To learn more about combining sick and well visits review the Provider Guidelines, Manuals, and Policies under the "Health Tracks" Section.

Is there transportation offered for Medicaid clients?

Members who need transportation assistance for medical appointments may call the customer support call center Toll-free at (866)-614-6005 to find options. Medicaid members can utilize low-income transportation options without prior approval if the transit provider accepts Medicaid. To locate a local transit provider please visit NDDOT Transit Provider.

Questions or Concerns? Contact Us

If you are a Medicaid provider with Health Tracks/Well-Child questions, please contact the Health Tracks Provider Outreach Team by emailing HTprovideroutreach@nd.gov

or calling (701) 328-2014 (then press 2) to connect to our team 

For questions about member eligibility, payments, denials or general claims questions:

Call (701) 328-7098, toll-free (877) 328-7098 or email inquiries to mmisinfo@nd.gov.

Send written inquiries to:

ND Medicaid Provider Enrollment
Noridian Healthcare Solutions
PO Box 6055
Fargo, ND 58108-6055

Email inquiries to NDMedicaidEnrollment@noridian.com
Call: (701) 277-6999
Fax: (701) 433-5956