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
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.
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.