Get the free FORM CMS-416 ANNUAL EPSDT PARTICIPATION REPORT - med-quest

Updated 10/22/2008 FORM CMS416: ANNUAL EPS DT PARTICIPATION REPORT Age Groups Hawaii QUEST Medical FY 2007 1. Total Individuals Eligible for EPS DT 2a. 2b. 2c. 3a. State Periodicity Schedule Number

How to fill out form cms-416 annual epsdt

How to fill out Form CMS-416 Annual EPSDT:

1. Obtain a copy of Form CMS-416 Annual EPSDT from the Centers for Medicare and Medicaid Services (CMS) website or local Medicaid office.
2. Begin by filling out the basic information section, including the name of the Medicaid agency, the reporting period, and the state/agency contact information.
3. Next, provide the title and contact information of the person responsible for completing the form.
4. Proceed to Section I: Screening Activity Information. Here, you should enter the total number of children in the Medicaid program, as well as the number of eligible children receiving screening services.
5. In Section II, you will need to report the total number of eligible children who received comprehensive screens by age group. Age groups typically range from infancy to adolescence.
6. Follow the instructions in Section III to report the number of children within each age group who were eligible but did not receive comprehensive screenings.
7. In Section IV, provide the number of children by age group who received immunizations or vaccinations.
8. Section V requires you to report the number of children by age group who had a referral for dental services.
9. If your state has additional measures to report, complete Section VI accordingly.
10. Finally, certify the accuracy of the information provided by signing and dating the form.
11. Submit the completed Form CMS-416 Annual EPSDT to the appropriate Medicaid agency or CMS as per their submission guidelines.

Who needs Form CMS-416 Annual EPSDT:

1. Medicaid agencies: Form CMS-416 Annual EPSDT is needed by Medicaid agencies to report on the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.
2. State authorities: It is required by state authorities responsible for monitoring the delivery and quality of Medicaid EPSDT services.
3. Healthcare providers: Healthcare providers who participate in the Medicaid program and offer EPSDT services are also affected by the data collected in Form CMS-416 Annual EPSDT.
4. Centers for Medicare and Medicaid Services (CMS): CMS utilizes the information from Form CMS-416 Annual EPSDT to evaluate and assess the effectiveness of the EPSDT program at a national level.

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What is form cms-416 annual epsdt?

Form CMS-416 Annual EPSDT is a reporting form used by Medicaid programs to collect data on the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.

Who is required to file form cms-416 annual epsdt?

Medicaid programs are required to file Form CMS-416 Annual EPSDT.

How to fill out form cms-416 annual epsdt?

Form CMS-416 Annual EPSDT can be filled out by providing the required information on the form, which typically includes data on EPSDT screenings, diagnostics, and treatments provided to Medicaid beneficiaries.

What is the purpose of form cms-416 annual epsdt?

The purpose of Form CMS-416 Annual EPSDT is to track and report on the utilization of EPSDT services by Medicaid beneficiaries.

What information must be reported on form cms-416 annual epsdt?

The information reported on Form CMS-416 Annual EPSDT typically includes the number of EPSDT screenings, diagnostics, and treatments provided to Medicaid beneficiaries.