Interventions and reminders

Preventive screenings

Independence Blue Cross (IBX) regularly reminds members about preventive screenings. These reminders encourage members to play an active role in their health care and take the time to get the following screenings:

• Colorectal screening
• Mammography screening
• Pap tests
• Prostate screening
• Lung cancer screening

We developed a one-page cancer screening flyer to help health care providers remind and educate their patients about recommended cancer screenings. This tool provides recommendations for colorectal, prostate, cervical, breast, and lung cancer for men and women at average risk. The information is adapted from nationally recognized health resources and is routinely updated to help keep our members informed and in good health.

Lead testing and developmental screening for children

Screening recommendation

The Pennsylvania Department of Human Services (DHS) and Healthcare Effectiveness Data and Information Set (HEDIS^®) specifications recommend that children receive testing for elevated blood lead levels (EBLL) and developmental screening.

Who should be screened

Practitioners are encouraged to follow the Medicaid and Bright Futures™ guidelines for lead testing and developmental screening:

• A lead blood test should be completed at ages 9 to 12 months and, again, by 24 months.
• For children turning ages 1, 2, or 3, a screening for developmental disorders using a standardized and validated screening tool should be completed, even when there are no concerns.
• Screening should be completed more often if there are concerns or additional risk factors.

Lead testing PEAR report

To support providers in testing for lead poisoning, IBX created customized reports on the Provider Engagement, Analytics & Reporting (PEAR) portal that allow providers to easily see which of their pediatric patients need a lead test, need a retest, or have proof of a lead test.

How to access the report

1. Sign into PEAR.
2. Select the Analytics & Reporting application.
3. Go to the Output Manager.
4. Find the report under Published Reports with a document type Member Lead Testing Report.

How to use the report

• Letter: Explains why the lead testing report was created and what action providers need to take.
• Selection Criteria: Outlines the requirements used when selecting patients for the lead testing report.
• Member Roster: Lists your patients (our members) who need a lead test, need a retest, or have proof of a lead test.

If you have questions about accessing your report, please contact PEAR Support at 1-833-444-PEAR (1-833-444-7327).

Where and how can children be tested?

To increase blood lead level screening rates in children and help address gaps in care, our Enhanced Lead Testing Program provides several testing options for patients who face barriers to getting tested:

• Lead testing in the provider’s office
  Providers can perform the lead test sample collection during a routine office visit, using the filter-paper testing method. An alternative to the traditional lab-based collection process, the filter-paper testing method only requires two drops of blood.
• Lead testing at Labcorp patient service centers, including Labcorp at Walgreens
  Patients can also receive a lead test sample collection at any participating Labcorp patient service center (PSC), including Labcorp at Walgreens.* All tests are performed at a Labcorp lab, with results delivered to you in a few days. Patient caregivers can schedule a test online

* Use CPT^® code 36416 to report the collection of the blood sample in the office or at a Labcorp patient service center, including Labcorp at Walgreens locations. Use CPT code 83655 to report the analysis/testing of the blood sample.

Developmental screening documentation and resources

Examples of validated developmental screening tools are available on the Bright Futures™ website:

• Infancy
• Early childhood

Use CPT code 96110 to report the completion of developmental screenings and add screening documentation to the member’s chart.

The Philadelphia Department of Public Health offers a brochure that outlines recommended developmental screening tools, FAQs, billing tips, and screening workflow recommendations. Referral forms and an overview of Early Intervention agencies are also available for children in Philadelphia county.

Philadelphia residents can view the Check and Connect Brochure for more information.

Providers can refer children who have been identified with a suspected developmental delay to one of the local Early Intervention agencies listed below. Families and providers who have questions about a child’s development may also call the CONNECT Helpline: 1-800-692-7288.

Important well-child visits to remember:

Providers are asked to perform well-child visits in accordance with the following:

• Six or more well visits by age 15 months
• One or two well visits by age 30 months

CPT Copyright 2024 American Medical Association. All rights reserved. CPT^® is a registered trademark of the American Medical Association.

W30 PEAR report

To support providers in completing W30 Well Visits and closing W30 gaps in care, IBX developed a report that allows providers to see which of their pediatric patients (our members) need preventive W30 Well Visits or have gaps in clinical care in the first 30 months of life.

Available on the PEAR portal, this report indicates whether your pediatric patients are eligible for a W30 Well Visit, or if they have missed an important wellness visit and need additional support to catch up on immunizations and other key tests, such as lead testing.

How to access your report:

1. Sign in to PEAR portal.
2. Select the Analytics & Reporting application.
3. Go to Output Manager.
4. Find the report under Published Reports; document type is Attributed Member Snapshot.
5. Open the report and click on the Member Snapshot tab.
6. Find the column titled “Well child visits in first 30 months."

“Closed" means the patient is compliant for the measure; “Open" means the patient has a gap for the measure.

If you have questions about accessing your report, please contact PEAR Support at 1-833-444-PEAR (1-833-444-7327).

Health and wellness

IBX members can find information about important health issues and services to improve the well-being of their families:

• Achieving well-being
• Nutrition and weight management
• Physical health resources
• Immunizations and vaccines
• Preventive care
• Behavioral health benefits
• What you need to know about opioids/resources
• Maternity and health resources
• Health Coaches
• Financial well-being
• Discounts and reimbursements

Chlamydia

According to the Centers for Disease Prevention and Control (CDC), “chlamydial infection is the most frequently reported infectious disease in the United States, and prevalence is highest in persons aged ≤24 years.” Left untreated, chlamydia can cause serious pelvic inflammatory disease (PID), ectopic pregnancy, and infertility.

The CDC states, some women who receive a diagnosis of uncomplicated cervical infection already have subclinical upper-reproductive–tract infection. The CDC also reports that asymptomatic infection is common in both men and women. To detect chlamydial infections, health-care professionals frequently rely on screening tests. Annual screening is recommended for all sexually active adults and children.

Health care professionals are encouraged to refer to the Preventive Services Task Force Guidelines for details of screening recommendations. They can also refer to our Medical Policy Statement for coding details.