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July 24, 2017

Early Periodic Screening, Diagnosis and Treatment (EPSDT)

The Early, Periodic, Screening, Diagnostic and Treatment (EPSDT) benefit allows a child under 21 to receive medically necessary services that exceed the limits of the Idaho Medicaid plan.

The EPSDT Request for Additional Services form is used to request services not typically covered by Idaho Medicaid. It must be completed and signed by the parents/guardians (or a participant over 18). The primary care provider MUST complete and sign their section of the form before Medicaid can approve or deny the request for the treatment/service.

The parents/guardians (or the participant) will receive a Notice of Decision from the Department telling them if the request was approved or denied. The Notice of Decision may also list alternative services that are available. If the request is denied, parents/guardians may appeal the decision. Instructions for appeals are on the Notice of Decision.

The status of a prior authorization request for medical services may be checked by providers online at the Molina Health PAS portal under “Authorization Status”, using your NPI, or by contacting Molina at 1 (866) 686-4272. Please, remember that billing must reflect the service code and modifiers shown on the authorization approval.

Outpatient mental health and substance use disorder services are provided by Optum Idaho.  If you have questions regarding these services, please call 1 (855) 202-0973 or visit Optum’s website.

Dental services are provided by MCNA Dental through the Idaho Smiles program.  If you have questions regarding these services, please call (855) 233-6262 or MCNA Dental's website.

For other questions, or general information, please email your request to
EPSDTrequests@dhw.idaho.gov.