Ped-I-Care is a health plan for special needs children operating under the auspices of the University of Florida College of Medicine’s Department of Pediatrics. It functions under a contract with the Department of Health’s (DOH) Children’s Medical Services (CMS) Division. CMS designated this contracted service as a Pediatric Integrated Care System (ICS).
This ICS is known as Ped-I-Care, and it provides care to children with special health care needs from the age of one year until the child reaches his/her nineteenth birthday. It is implemented in collaboration with the local CMS offices, which continue to provide nurse care coordination for the members and providers as well as on-going support for the pharmacy benefits program.
Translation services are available for members. Additionally, written materials may be provided in various languages. Braille and audio services are available when necessary.
In The News
Attention Ped-I-Care Providers
Effective immediately referrals are no longer necessary for contracted and credentialed providers. ALL non-credentialed and non-contracted providers will still be required to obtain prior authorization.
NOTE: This does NOT eliminate the requirement for authorizations to be obtained for services and procedures that require a prior authorization. Information regarding these processes and forms are contained within the Utilization Management section of our provider manual at http://pedicare.peds.ufl.edu/.
Title XIX Expansion – August 1, 2014
Under the Managed Medical Assistance (MMA) component of the Statewide Medicaid Managed Care (SMMC) program, Children’s Medical Services (CMS) has formed a health plan known as Children’s Medical Services Network Specialty Plan (CMSN). CMSN has contracted with two Provider Service Networks (PSNs), Ped-I-Care (in 51 counties) and South Florida Community Care Network (SFCCN) in 16 counties, to provide a number of administrative services, as well as the provider network for the plan. Statewide MMA implementation for these groups is effective August 1, 2014.
Improving Transition of Care: Free Resources from FloridaHATS
Physicians, learn more about the AAP’s recommendations for transition planning as a standard of care. The FloridaHATS organization offers a wealth of free resources for preparing adolescents and their families for the transition to adult care. Click here for more information.
Child Health Check-Ups Are Important!
Has your child had a check-up this year? A check-up is different from other doctor’s visits. A check-up gives time for you and your child’s main doctor to talk about your child’s overall health. CMS/Ped-I-Care pays for this. With so many specialist visits to keep track of, it can be difficult to remember that check-ups are important, too. Your CMS Nurse Care Coordinator can help you schedule this.
- Kids need check-ups throughout their childhood:
- As infants – At 1, 2, 4, 6, 8, 12, 15, 18, 24, and 30 months
- During the early years – Once per year; they may also need shots
- During adolescence – Once per year; they may also need shots
Please make sure all CMS/Ped-I-Care patients have their CHCUPs according to the AAP’s periodicity schedule .
eINFOsource Training Opportunities
MED3OOO will host a series of webEx training sessions on the use of the eINFOsource web-portal. In order to participate in a session please contact the Provider Network Services Help Desk of MED3OOO to obtain the information necessary for participation. We can be reached by phone at 1-866-703-1444 (toll free) or 1-850-505-4090 or via email at Fl_Support@MED3000.com.
UF Ped-I-Care was nationally recognized for innovation in improving community health. Read the article.
Changes to Ped-I-Care Claims Submissions
Ped-I-Care’s Third Party Administrator (TPA), MED3000, has entered into a relationship with Emdeon, a leading provider of revenue and payment cycle management. Due to this relationship, there will be changes to Ped-I-Care claims submissions, for both Title XIX (T19) and Title XXI (T21) paper and electronic claims.
Med3000 recently performed upgrades to eINFOsource that include changes to search functionality and services authorization submissions. View the summary of changes. If you have questions or would like to schedule refresher training on the use of the provider portal please contact Med3000 by calling 1-866-703-1444.
Please visit News and Information page under quick links for current events and updates.
Performing a blood test for lead levels is a Federal and State requirement at specific intervals during the Child Health Check-Up (CHCUP). CMS/Ped-I-Care Title XIX Medicaid Reform children are covered by the same Federal and State requirements as other Medicaid children.
The Federal regulation as referenced in the Child Health Check-Up Coverage and Limitations Handbook, October 2003, pages 2-13 and 2-14, and pages 3-6, requires that all Medicaid children receive a screening blood lead test at the ages of 12 months and 24 months, and between the ages of 36 months and 72 months if they have not been previously screened for lead poisoning. When you order the blood lead test, it needs to be documented in the medical record. The result of the test also needs to be documented.
To meet the Medicaid requirement a blood test must be done. Performing a risk assessment alone does not meet this requirement. Whether you draw the blood in your office or you send the member to the lab, your office should report the additional ICD-9 code V82.5 for the blood lead screening test.
The Child Health Check-Up Coverage and Limitations Handbook can be accessed by visiting http://mymedicaid-florida.com. Click on Public Information for Providers, Provider Support, then Provider Handbooks, and select the Child Health Check-Up Handbook.
If you have any questions or need a list of members assigned to your practice that are under 3 years old, please feel free to contact us at (866) 376-2456.