EPSDT: Connecting care providers and members

Anthem Blue Cross and Blue Shield (Anthem) has processes in place for our members under the age of 21 years old to ensure care that prevents, detects, and treats medical, social, educational, and other needs identified for our members. This care falls under our Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) coverage. This program follows state guidelines of what care is recommended by age for eligible members to receive medical care, dental care, health screenings, mental health screenings, and social needs assessments and interventions.

The EPSDT program uses internal reports to identify eligible members that are under 21 years of age. These reports identify members who are compliant with appropriate age care and those who have identified gaps in care. Anthem sends reminders to members for needed care and services offered, like transportation, to help the families and members who need connection to care.

What does that mean for you as a care provider?

Anthem will help connect members to you! We cover all the necessary appointments and needs for our members to keep wellness at the forefront for them and help break down barriers they face when getting the care they need. Anthem will use the data collected for our members and help direct them to you based on geographic location, care needs by age, and specialty. Anthem sends reminders, campaign information, and outreaches to members based on their preferences by text or email.

For care providers who are part of our comprehensive maternal care (CMC), comprehensive primary care (CPC), and/or OhioRISE programs, we can help you set up access with direct communication through our care coordination portal (CCP) to make it easier with data sharing and digital communication. You can access this through the Care360 portal. If you do not have access, select the Go To OH|ID button to create an account. There are resources available for login help.

We look forward to partnering with you. Anthem strives to be the bridge between the member and you, as their care provider. For general concerns, contact Member Services at 844-912-0938, or call 844-912-1226 for authorizations, claims, or any other billing needs.