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Our training

We make sure providers have the right tools and resources to take care of our members. On this page, you’ll find helpful links and training opportunities to boost your knowledge and serve your community.

 

Questions?

Just call Provider Experience at 1-855-221-5656 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 5 PM. 

Getting started

Getting started

When you join our network, we’ll provide an initial orientation. After that, you’ll have ongoing training and education, including webinars, periodic provider newsletters and bulletins, and so much more.

 

Questions about joining our network? Just visit the join our network page for more information.

 

You can also check the quick reference guide or the provider manual for answers to many of your questions. Or you can call us at 1-855-221-5656 (TTY: 711).

 

Quick reference guide (PDF)

 

Provider manual (PDF)

 

New provider training and resources

Take part in a session and we’ll share helpful information, including:

 

• Contract requirements and amendments

• Special needs of the members served by the provider

• Service coverage guidelines

• Prior authorizations

• Billing procedures and claim submission

• How to learn more about your provider portal and other information

 

How to join

You can register to join an orientation training session. If you have questions, you can email us. Or call 1-855-221-5656 (TTY: 711). 

 

Upcoming sessions

 

You can join the rest of our provider community by attending our provider town halls.

 

How to join

You can register to join a town hall. Just choose a date to register.
 

Upcoming sessions
 

Questions? Just email us. Or call 1-855-221-5656 (TTY: 711).

 

 

 

 

Availity® training

 

The Provider Portal is an online tool that lets us communicate health care information directly to  providers. In 2021, we transitioned from the Medicaid Web Portal (MWP) to Availity as our Provider Portal.

 

You need to register for the Availity Provider Portal before you can start using its many features. To learn more about how to register for the Availity Provider Portal, just visit the Provider Portal page.

 

Get training on Availity
 

Setting up your account with Availity (PDF)

Other training, materials and resources

 

You can take part in our provider refresher course to review helpful information including:
 

  • Requisitos de contratación y enmiendas

  • Members’ special needs and how you can serve them

  • Pautas de cobertura de servicios

  • Autorizaciones previas

  • Procedimientos de facturación y presentación de reclamaciones

  • How to find more resources and information

Staff can also answer any of your questions about other topics, such as the provider portal.
 

How to join a training session

All sessions are held virtually. You can register to join a Provider 101 Refresher training session. Just choose a date for an upcoming session.

 

Upcoming sessions
 

 

 

 

Questions? Just email us. Or call 1-855-221-5656 (TTY: 711).

We strongly encourage all providers to learn more about cultural competency. Patient satisfaction and positive health outcomes are directly related to good communication, in a culturally competent manner, between a member and their provider.  
 

Providers should receive education about topics, such as:

  • The reluctance of certain cultures to discuss mental health issues and the need to proactively encourage members from such backgrounds to seek support

  • The impact that a member’s religious and/or cultural beliefs can have on health outcomes (example: belief in non-traditional healing practices)

  • Health illiteracy and the need to provide patients with understandable health information (example: simple diagrams, communicating in the vernacular, etc.)

  • History of the disability rights movement and the progression of civil rights for people with disabilities

  • Physical and programmatic barriers that impact people with disabilities accessing the right care

More about cultural competency
 

How to join a training session
 

You can register to join a cultural competency training session.

Upcoming sessions

  • March 21, 2024 from 10 AM to 11 AM — Register
  • June 20, 2024 from 10 AM to 11 AM — Register
  • September 19, 2024 from 10 AM to 11 AM — Register
  • December 19, 2024 from 10 AM to 11 AM — Register

 

You can register to join an orientation session through the individual registration links below. If you have questions, you can email us Or call 1-855-221-5656 (TTY: 711)


 

More resources


Cultural competency plan (PDF)

Cultural competency training presentation (PDF)

 

EPSDT services are a comprehensive array of prevention, diagnostic and treatment services for low-income infants, children and adolescents under age 21 (as specified in Section 1905(r) of the Social Security Act). The EPSDT benefit is more robust than the Medicaid benefit for adults and is designed to assure that children receive early detection and care, so that health problems are averted or diagnosed and treated as early as possible.


We’re committed to ensuring that the children we serve will receive health care they need when they need it, in the right setting. Our webinar covers all aspects of an EPSDT exam including best practices related to EPSDT services.

 

How to join a training session


You can register to join an EPSDT training session. Just choose your preferred session date to register.

Upcoming sessions

 

If you have questions about EPSDT or this presentation, please email the Aetna Better Health of Kansas Quality Management Department at ABHKS_QM_Operations@aetna.com

 

 

No.

TIME CODE

CAPTION

1

00:00:02:17

Welcome to the webinar.

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00:00:05:00

Today, I will be presenting a general overview

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00:00:08:00

of the EPSDT program

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and how Aetna Better Health of Kansas can support your practice

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as they navigate the EPSDT benefit for children on Medicaid.

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00:00:21:00

So first, let's review what EPSDT means.

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You'll find the acronyms spelled out on the slide.

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Here we have E for early,

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as in assessing for and identifying potential health concerns

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on a timely basis.

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Periodic,

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monitoring overall health at age-appropriate times.

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Screening, providing appropriate screening tests.

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Diagnosis, includes follow up and referrals

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when a health risk is identified.

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And treatment, meaning correction, reduction,

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or maintenance of health problems identified.

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As a reminder, EPSDT is a federally-mandated benefit

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that supports children throughout their growing years

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in order to ensure they receive the care they need

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by supporting their physical health, mental health, and development.

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Note that Kansas follows

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the American Academy of Pediatricians' Bright Futures periodicity schedule

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regarding recommended visited timeline.

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EPSDT covers children from birth up to the age of 21

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and includes children in the foster care system.

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Members do not sign up for this program.

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They are automatically enrolled if they meet the age requirement.

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In the same way, members cannot opt out of EPSDT.

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They KanBeHealthy exam, or the KBH, is the starting point for EPSDT.

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In other words,

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this is how most members will access the benefit.

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The KBH begins the process of screening children,

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and the vast majority of children

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may not need the other services EPSDT covers.

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However, without regular KBHs,

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conditions that are treatable may be missed.

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This slide lists out the benefits of an annual KanBeHealthy visit.

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We have making sure required health care resources

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are available and accessible.

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It assists families by helping Medicaid recipients

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and their parents or guardians

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effectively identify and use these resources,

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by assessing the individual child's needs

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through initial and periodic examination and evaluation,

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assisting with early diagnosis and treatment of health problems

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by including medical, vision, dental, and hearing screenings,

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as well as referrals and treatments,

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by including developmental screenings to include identification, referral,

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and treatment of delays in a child's development,

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by including diagnostic services

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when a screening indicates the need for further follow up.

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This slide goes into more information on what services ABH covers

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and the focus of the EPSDT program.

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So, EPSDT is a key service

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that ensures children and adolescents under age 21

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receive appropriate preventative physical,

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dental, mental health, developmental, and specialty services.

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The overall goal of the program

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is to ensure that individual children and adolescents get the care they need

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when they need it –

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the right care to the right child at the right time in the right setting.

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This slide discusses what ABH does

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to make sure our members are aware of the EPSDT program.

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You might have seen a member handbook.

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These are sent after enrollment in Medicaid,

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and it contains information on EPSDT services.

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Our members also receive text reminders,

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IVR reminders via our outreach campaigns.

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These are sent to the parents or guardians about our healthcare visits that are due.

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Educational materials are also made available.

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These are also mailed to the parents and guardians.

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Our foster care contractors receive gap in care reports

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and these reports provide information regarding when a KBH visit is needed,

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as well as educational materials that are handed out at community events.

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We just participated in the event in Kansas City, Kansas.

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It was the Vibrant Health fair,

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and our table had so many different brochures and pamphlets

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in English and in Spanish,

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and we were able to engage with a lot of our community.

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That was a lot of fun.

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Now, I'll start discussing the individual steps in EPSDT

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The 1st letter E stands for early.

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The earlier conditions are identified, the more successful the treatment.

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Here, we have an example at the bottom of the slide

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where a mom takes her nine-month-old son to the pediatrician for a well visit.

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The second letter stands for periodic.

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Here's where the Bright Futures schedule really comes into play.

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Making sure the parents understand the recommended schedule of visits.

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You may have received access to a patient portal as a parent

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that reminds you of your child's visit.

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You may have also received a pamphlet or a little booklet

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to remind you and keep track of your baby's growth and development.

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Those can all be examples

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of that periodicity schedule that we follow.

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Next letter stands for screening.

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This slide lists the various types of screenings

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that children should receive during the KBH

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as they grow and develop.

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Again, an example of what this screening entails

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can be a mom expressing concern

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that her nine-month-old son isn't sitting up on his own

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during the check up,

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and then the pediatrician will come in and complete a full exam,

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obtain all of that physical history during the appointment.

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Regular screening tests help detect potential health concerns,

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and they include health and developmental history,

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including behavioral health, comprehensive physical exams,

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appropriate immunizations, laboratory testing,

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vision, dental, hearing, and lead screening.

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Now, lead screening receives it's own slide here,

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because it's an important screening test and it's a required component of EPSDT.

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The KBH includes a verbal screening for lead,

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but this does not count as an actual lead screening.

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All that screening must consist of a serum blood test

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and should be completed before the child turns two.

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However, for children older than two who have not previously been screened,

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this test should be completed as soon as possible,

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no matter the age.

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00:08:48:08

The 4th letter stands for diagnosis.

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Some screenings may identify concerns and additional testing is required.

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The provider should make a referral as soon as the concern is identified

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so that the child can receive treatment if necessary.

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00:09:05:03

Note the example at the bottom of the slide

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where the pediatrician notes the delays in motor skills

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00:09:12:00

Let's say were discussing that nine-month-old son

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that the mom brought in,

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the pediatrician will then create a referral

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to see a physical therapist

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that specializes in children's development.

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The final letter, T, stands for treatment.

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Once diagnosed,

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the goal is to have the child receive treatment right away

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so that problems can be corrected.

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Some problems may not be able to be fully corrected,

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but treatment can lessen the severity

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and ensure the child is able to live their fullest life.

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Here, again, is another example

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where the child begins therapy sessions with the physical therapist

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and future visits with the original pediatrician

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00:10:04:20

will evaluate the progress of those physical therapy visits

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and make further recommendations as needed.

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This slide introduces the terminology "medical necessity."

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Most services are included in the EPSDT benefit,

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but on occasion,

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a provider may recommend a treatment that is not routinely covered,

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but that the provider considers medically necessary.

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The EPSDT benefit can cover these services

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once a medical director on the Aetna team approves the provider's plan

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and agrees with the medical necessity of the service.

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00:10:51:16

You will see on the slide the three bulleted items

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which, according to Kan Care and Aetna,

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would not be considered medically necessary.

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00:11:00:17

So, here, we have experimental treatments or items,

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services or items determined to be unsafe or ineffective,

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and services specifically for caregiver convenience.

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Services cannot be denied arbitrarily;

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it will still go through that approval process.

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And a continuation of the discussion on medical necessity,

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states such as Kansas can determine limits

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for any services considered medically necessary,

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and Aetna is required to uphold any limits KanCare stipulates.

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This slide talks about

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the Managed Care Organizations' responsibility

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in determining medical necessity.

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Each case is reviewed by both a nurse and a physician,

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and the guidelines used are national standards.

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The medical director makes the final determination.

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However, providers can appeal these determinations if they desire.

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A side note here,

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the more information provider offices can add to the initial PA form,

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the better.

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In many instances,

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additional information given during the appeal

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is enough to overturn the initial determination.

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In the case of any dispute, the state makes the final determination.

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This slide walks through an example of a child who was diagnosed with ADHD,

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where the mother is seeking respite care services.

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Under the current guidelines,

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respite care is not covered by the EPSDT benefit,

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therefore, this request would be denied.

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So, to recap,

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EPSDT covers children from birth up until they turn 21.

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Children should be receiving annual well-child or KBH visits

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so that their growth and development can be tracked

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and any problems or concerns identified early.

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By staying on track,

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health concerns can be treated early and either corrected or lessened.

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The number at the bottom was the number of children in Kansas

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that would be covered by EPSDT as of August 2022.

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So, I wanted to leave our contact information here.

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We have a Carson Boyd.

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She's our HEDIS quality management manager

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and her email is boydc@aetna.com.

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She can be contacted for any HEDIS-related questions.

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And myself, Tiffany Barrett, I am the EPSDT coordinator here,

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and my email address is barrettt6@aetna.com.

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I can be reached out to for any EPSDT-related question.

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And does anyone have any questions that I may be able to address here?

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We have a little bit of time left.

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Okay. Well, that concludes today's webinar.

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Thank you for joining.

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I will be sending everyone a copy of the slides

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and the participation survey.

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I'll give you your time back. Everyone, have a great day.

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You, too. Thank you.

Trauma-informed care responds to the impact of trauma through recognition and understanding. We take our members’ safety and ability to make their own choices seriously. Want to learn more? Just watch this video about trauma-informed care. Or visit the Center of Excellence for Integrated Health Solutions (CoE) website

You can find more information about training on the HEDIS page.

Communication between health care professionals can lead to better outcomes for patients. Not sure where to start? You can check out these FAQs about how to discuss sensitive topics. 

When and how can you share info about patients you’re treating for mental health conditions?

What are some ways to address social determinants of health challenges?

Where can you learn more about the HIPAA privacy rule?

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

Also of interest: