One of Jefferson Health Plans’ primary goals is to ensure our youngest members receive the preventive care they need. That’s why we want to remind you that you can complete a well-child visit once every year, even if 365 days have not yet passed since their last well visit in the prior calendar year. Providers will be reimbursed as long as it is a new calendar year.

You can also complete a well-child visit when a child comes in for a sick visit. You should do this after determining that the condition, illness or injury that led to the sick visit does not impede the ability to complete a well-child visit and that the child is eligible for the well-child visit, per their Care Gap Report. Based on our claims data, many provider offices miss this opportunity. Well-child visits often do not occur or the submitted claims do not accurately capture the rendered services. When services are documented and billed properly, offices can close care gaps and significantly increase revenue. We want to ensure that our providers are reimbursed properly for the care provided.

Your office can submit claims for both a sick visit and a preventive well-child visit for services provided on the same day, by adding the Modifier 25 to the claim. In order to bill for the well-child visit, all components must be addressed, and providers must have proper medical record documentation to support the CPT codes and the E/M codes billed. For more information about proper billing and documentation, please visit www.HealthPartnersPlans.com/PediatricCareInfo.

If you have additional questions, contact our Provider Services Helpline at 1-888-991-9023, Monday – Friday, 9:00 a.m. – 5:30 p.m. Thank you for your support in providing the highest quality of care to our