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AMP CHAPTER 400, MEDICAL POLICY FOR MATERNAL AND CHILD HEALTH AMP POLICY 430, EXHIBIT 4301, AHC CCS EPS DT PERIODICITY SCHEDULE PROCEDURE/Agnew born35 days 1 mo2 mo4 mo6 mo9 mo12 mo15 mo18 mo24 mo3

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How to fill out arizona ahcccs epsdt periodicity

01

To fill out Arizona AHCCCS EPSDT Periodicity, follow these steps:

02

Obtain a copy of the AHCCCS EPSDT Periodicity Schedule form.

03

Fill in the child's personal information, such as name, date of birth, and AHCCCS ID number.

04

Provide details about the child's primary care provider, including the name, address, and contact information.

05

List any specialist providers, if applicable, along with their contact information.

06

Indicate the child's medical history, including any existing conditions, medications, and allergies.

07

Provide information about the child's immunizations and immunization history.

08

Record any developmental assessments or screenings that the child has undergone.

09

Note any dental services the child has received, including cleanings, fillings, or extractions.

10

Document any vision and hearing screenings or tests that have been performed.

11

If additional information or attachments are required, ensure they are properly included with the form.

12

Review the completed form for accuracy and completeness.

13

Submit the filled out AHCCCS EPSDT Periodicity form according to the specified submission process.

Who needs arizona ahcccs epsdt periodicity?

01

Arizona AHCCCS EPSDT Periodicity is needed by children who are enrolled in the Arizona Health Care Cost Containment System (AHCCCS) and are eligible for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services. EPSDT is a comprehensive child health program that ensures eligible children receive preventative and diagnostic care, as well as necessary treatment services.

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What is arizona ahcccs epsdt periodicity?

Arizona AHCCCS EPSDT periodicity refers to the schedule at which EPSDT screenings must be performed for eligible children to ensure their healthcare needs are being met.

Who is required to file arizona ahcccs epsdt periodicity?

Healthcare providers who serve Medicaid recipients in Arizona are required to file Arizona AHCCCS EPSDT periodicity.

How to fill out arizona ahcccs epsdt periodicity?

To fill out Arizona AHCCCS EPSDT periodicity, healthcare providers must follow the guidelines provided by AHCCCS and submit the necessary documentation regarding the EPSDT screenings.

What is the purpose of arizona ahcccs epsdt periodicity?

The purpose of Arizona AHCCCS EPSDT periodicity is to ensure that eligible children receive required screenings and preventive services to maintain their health and well-being.

What information must be reported on arizona ahcccs epsdt periodicity?

Information reported on Arizona AHCCCS EPSDT periodicity may include the dates of screenings, results of screenings, and any follow-up care recommendations.

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