Health Tracks Benefits
North Dakota Health Tracks, also known as the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, is a preventative health care benefit for newborns, children and young adults through age 20 who are enrolled in Medicaid. To see if you are eligible for North Dakota Medicaid see income guidelines.
The intent of the ND Health Tracks/Well Child Checks benefit is to focus on early prevention and treatment, assure the availability and accessibility of required health care resources and help members and their parents or guardians effectively use services.
The federal guidelines for EPSDT are available at www.medicaid.gov.
The Health Tracks/Well-Child Benefit Must Include:
- Comprehensive health and developmental history including assessment of both physical and mental health development
- Comprehensive unclothed physical exam
- Appropriate immunizations
- Laboratory tests (including Lead Toxicity screening) and
- Health education/anticipatory guidance
- Vision services including evaluation and treatment for defects in vision
- Dental Services including fluoride varnish, sealants, relief of pain and infections, restoration of teeth and maintenance of oral health. May include an orthodontia screening
- Hearing Services including evaluation and treatment for defects in hearing, including hearing aids.
- Other necessary health care services to diagnose and treat physical and behavioral health illnesses, defects and conditions discovered through a check-up.
Additional Services Such As:
- Orthodontia Screening
- Dental examinations
- Transportation and scheduling assistance
- Follow up care with Specialists
Recommended EPSDT Periodicity Schedule:
|newborn||2 month||9 month||18 month|
|3-5 days||4 month||12 month||24 month|
|1 month||6 month||15 month||30 month|
|Or age 3 through age 20, annually|
Health Tracks/Well-Child Checks Provider Toolkit
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 Developmental Screenings and Brief Behavioral Assessment Coding Guidelines 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:
Please visit ND Medicaid Coding Guideline for Maternal Depression Screening 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
- Fluoride Varnish Fact Sheet
- Fluoride Varnish Fact Sheet Dept. of Health
- 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 email@example.com 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 firstname.lastname@example.org
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.
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:
Resources for Provider
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 the General Medicaid Manual under the “Health Tracks” 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.
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).
It is recommended that a patient’s primary care 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
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)
|FQHC||0521||S0302 or 9938x/9939x|
|RHC||0521||S0302 or 9938x/9939x|
|IHS||0519||S0302 or 9938x/9939x|
All other providers
|N/A||S0302 or 9938x/9939x|
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 - AVRS 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 email@example.com.
Inviting Your Patients to the Office
For providers with a panel of patients, we will provide you with Gap-in-Care Reports and letters which will identify which of your patients are due or past due for a Health Tracks screening/Well-Child Check. For providers who provide Health Tracks Screenings and do not have a designated panel of patients, we will provide you with a monthly Outreach list which will identify members who have been notified that they are due for a Health Tracks Screening/Well- Child Check. You can utilize these resources to help increase preventive care in your office.
Below are links to flyers and script examples you can use when conducting outreach:
Regular initial outreach:
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 are emailed monthly to local public health units who offer Health Tracks screenings as a service. 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 General Providers Manual.
How are patients assigned a PCP?
The Primary Care Case Management (PCCM) program requires most members to choose a Primary Care Provider (PCP) to help manage their health care needs and provide referrals for specialty services as needed.
Members required to enroll in PCCM must select a PCP within 14 days of their approval for Medicaid eligibility. Members that do not select a PCP within this time period are “Auto” assigned a PCP by ND Medicaid. Once a PCP is selected or assigned, a member must follow the requirements of the PCCM program. For additional information please see North Dakota Medicaid Provider Manual - PCCM Section or PCCM Website
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.
Why do I receive monthly letters (ND-RP-01-0075) each month?
All PCPs who have a panel of patients will receive this letter monthly identifying patients that are assigned to them and are due for a Health Tracks/Well-Child Visit.
Why are children who are not my patients on my list?
- All PCPs who have a panel of patients will receive a letter monthly (ND-RP-01-0075) identifying patients that are assigned to them and are due for a Health Tracks/Well-Child Visit.
- If you find a name on your list that is not a current patient, they may have been auto assigned to you or they selected you as their PCP but has not scheduled an initial appointment. We would encourage you to reach out to these patients to schedule a Health Tracks/Well-Child Visit.
- If you find that they have moved or would like to select a different PCP, we encourage you to remind them to contact their local Human Service Zone to update their information.
What if I no longer or have never provided PCP services?
If you are PCP that is no longer accepting new patients or no longer serving a panel of patients and should be removed from the list, you can email firstname.lastname@example.org with the name of the person that needs to be removed.
What if one of my patients has questions about Medicaid member eligibility, denials, or other claim issues?
Members have the right to request a change of their PCP selection. They may make either an oral or written request to their local human service zone eligibility worker.
Human Service Zone Contact Information
What if I have questions about member eligibility, denials, or other claim issues
- Please reach out to the ND Medicaid call center at (701) 328-7098
- 1-844-854-4825 Medicaid Eligibility Call Center
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 email@example.com 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 General Medicaid Manual under the “Health Tracks” section.
Can my patient be seen at a walk-in/urgent care clinic not affiliated with my provider group?
Yes, walk-in/urgent care clinics are allowed 15 working days from the date of the service to obtain a referral from the patient’s PCP for all services provided. Please see the General Provider Manual under the “PCCM” section
Is there transportation offered for Medicaid clients?
If a client needs transportation, they may contact their local Human Service Zone to find out if they are eligible for transportation benefits and their 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 firstname.lastname@example.org.
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
Medical Services Division
North Dakota Health and Human Services
600 E. Boulevard Ave., Dept. 325
Bismarck, ND 58505-0250
Phone: (701) 328-7068
Toll-Free: (800) 755-2604
Fax: (701) 328-1544