As a pediatric PCP, you're a trusted advisor, early interventionist and vital support system for countless families. You play a vital role in:
- Crucial vaccination timing
- Family support and education
- Chronic condition management
- Community resource connections
- Developmental milestone monitoring
- Early detection and intervention opportunities
We're committed to increasing the number of children receiving six or more well-child visits during their first 15 months. The recommended schedule from the American Academy of Pediatrics (AAP) includes:
- Birth
- 3-5 days post-birth
- By one month
- 2, 4, 6, 9, 12, and 15 months
Proactive scheduling:
- Use automated reminder systems
- Book next visits before families leave your office
- Implement follow-up protocols for missed appointments
We've identified disparities in well-child visit completion rates, particularly among Hispanic/Latinx communities. Address health equity barriers by:
- Providing culturally sensitive care
- Offering language-appropriate materials
- Implementing flexible scheduling options
Use these codes for billing:
- CPT: 99381-99385, 99391-99395, 99461
- HCPCS: G0438, G0439, S0302
- ICD-10-CM: Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2
Explore these resources to enhance the well-child visit experience and improve outcomes for your patients.
Resources on our provider website
- Quality Improvement Toolkit: Search for the Well-child visits category for materials in English and Spanish about well-child visits
- Health Equity Toolkit: Find resources to develop and improve your office’s cultural competency and health literacy best practices.
Other resources
- Check out Bright Futures Health Care Professionals Tools and Resources.
- View vaccination schedules for children and adolescents, as well as catch-up schedules, published by the CDC.
Prioritizing women's health involves focusing on unique needs and challenges, encompassing physical, mental and reproductive well-being, with a focus on early detection and prevention of diseases, and promoting healthy lifestyles.
We cover these preventive care services at 100% for most members:
- Cervical cancer (Pap): Ages 21+
- Mammography: Ages 40+ or high-risk
- Human papillomavirus (HPV): Every 3 years (30+), immunizations through age 45
- Sexually transmitted infection (STI) screenings: gonorrhea, syphilis, chlamydia
- HIV screening/counseling: Ages 15-65 or high-risk
Members may not be aware that these services are covered by their health plan. They can view the list of covered services on our member website or by calling the Customer Service number on the back of their member ID card.
Closing the cervical cancer screening gap
We encourage you to schedule cervical cancer screenings with your patients who may be overdue. These screenings may find cancers earlier—when they are more easily treated. Women who have not been screened face the greatest risk of developing invasive cervical cancer.
Addressing the chlamydia crisis
Because people often do not have symptoms, many chlamydia infections go undetected and untreated, which can have severe long-term health consequences. The USPSTF recommends screening for chlamydia in sexually active women 24 and younger and in older women who are at increased risk for infection.
Search for Chlamydia screening in our Quality Improvement Toolkit to print flyers in English or Spanish to share with your patients. View the CDC’s chlamydia fact sheet.
Improving maternal health rates
The U.S. has some of the worst maternal and infant health outcomes among high-income countries, and people of color are disproportionally affected. Analysis of our claims data found that postpartum provider visit rates are low, especially for Black and Hispanic/Latinx members. We encourage providers to ensure all their patients’ maternal health and postpartum visits are scheduled so that mothers receive the support they need when they need it.
Our Health Equity Toolkit includes links to free maternal health training and resources for you and your staff. Our Bump2Baby Program provides personalized support from nurse care managers.
- Leverage electronic medical record reminders for screening due dates
- Implement proactive outreach for overdue screenings
- Educate patients about no-cost preventive services
- Schedule postpartum visits before hospital discharge
Connect patients with available support programs