How Does HealthCheck Work?
Even with uniform access to full benefit Medicaid coverage, the expansive mandate of HealthCheck "Other Services" has an important role to play in securing necessary coverage for children with exceptional health care needs.
"Other Services" can help bypass prior authorization requirements for certain types of over the counter medications and certain types of care can only be accessed through HealthCheck Other Services, such as day treatment or residential treatment for juvenile mental health or substance abuse issues.
In addition, some types of services, such as chiropractic care, in-home mental health services, and professional therapy services, are normally subject to restrictions such as visit or service limitations. In some fields of care, such as podiatry, standard Medicaid coverage may be limited only to specified types of procedures. Likewise, coverage for certain types of medical supplies or products may be limited to specific diagnoses or health conditions.
Through HealthCheck "Other Services", children can gain access to otherwise limited services whenever those services are medically necessary to correct or ameliorate a health condition.
Any Medicaid certified health care provider can request HealthCheck Other Services within 365 days of a screening. View the full list of HealthCheck-related forms on ForwardHealth.
Usually, the provider who will be delivering the requested services will submit the prior authorization request. For example, if a HealthCheck screening provider refers a patient for dental care, the dental provider will typically identify the medically necessary services and submit the prior authorization request. Likewise, if a patient is referred for an interperiodic mental health screening visit, the mental health provider will typically submit prior authorization requests for any medically necessary follow up and treatment services.
A provider requesting HealthCheck Other Services approval should complete the appropriate standard prior authorization form, and check the HCOS box at the top. When in doubt, write the words “HealthCheck Other Services” in red ink across the top of the first page! This step is important to ensure that the prior authorization form goes directly to the department responsible for processing Other Services authorization requests.
The prior authorization form should be accompanied by a copy of the HealthCheck screening verification and documentation supporting the medical necessity of the requested service. With the exception of certain over the counter medications, HealthCheck Other Services will not be covered without prior authorization approval.
Resources & Updates
- Resources for HealthCheck Providers, March 2019
- ForwardHealth Provider Portal HealthCheck User Guide, March 2019
- Clarifications to HealthCheck Services, February 2019
- Explanation of Prior Authorization Requirements for HealthCheck "Other Services", February 2019
- HealthCheck Other Services Presentation, Pam Lano DHS 2019