EPSDT-PCS 90 2010 free printable template

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How to fill out EPSDT-PCS 90

1. Start with your personal information: Enter your name, date of birth, and Medicaid number at the top of the form.
2. Fill out the date of service: Indicate when the EPSDT service was provided.
3. Specify the type of service: Check the appropriate boxes for the services rendered, such as screenings or assessments.
4. Provide detailed descriptions: Offer clear descriptions of each service provided, including duration and frequency.
5. Include provider information: List the name and credentials of the provider who delivered the service.
6. State diagnosis and treatment: Provide relevant diagnosis codes and describe any treatments or interventions performed.
7. Document follow-up actions: Note any follow-up plans or recommendations made after the service was provided.
8. Sign and date the form: Ensure that you, as the provider, sign and date the form to validate the information.

Who needs EPSDT-PCS 90?

1. Children under the age of 21 who are enrolled in Medicaid are required to undergo EPSDT screenings.
2. Providers who conduct EPSDT services must complete the EPSDT-PCS 90 form to document the care provided.
3. Families and caregivers of Medicaid-enrolled children may need this documentation to ensure continued access to necessary health services.

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What is EPSDT-PCS 90?

EPSDT-PCS 90 is a form used in the Medicaid program that outlines services provided under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program for children, specifically focusing on personal care services.

Who is required to file EPSDT-PCS 90?

Providers that deliver personal care services to eligible Medicaid recipients under the EPSDT program are typically required to file the EPSDT-PCS 90.

How to fill out EPSDT-PCS 90?

To fill out EPSDT-PCS 90, providers must complete the form with accurate information regarding the child's personal care needs, services provided, dates of service, and any relevant medical or other supporting documentation.

What is the purpose of EPSDT-PCS 90?

The purpose of EPSDT-PCS 90 is to ensure that children receiving Medicaid benefits have access to necessary personal care services and to document the services provided for compliance and reimbursement purposes.

What information must be reported on EPSDT-PCS 90?

Information that must be reported on EPSDT-PCS 90 includes the child's name, Medicaid number, service dates, type of service provided, provider information, and a description of the child's personal care needs.