Provider Alert! Infant Well-Child Visit Reminder

Date: February 28, 2024

Attention: Primary Care Providers

Call to action: Texas Children’s Health Plan (TCHP) encourages providers to ensure their infant patients are receiving timely well-child visits and immunizations, in compliance with the Texas Health Steps (THSteps) periodicity schedule. More specifically, visits must be scheduled on or before the patient’s birth month in order for them to be considered compliant with Health and Human Services (HHSC) THSteps requirements.  TCHP is committed to ensuring members recognize the importance of preventive care and is working with members to better understand and address member barriers to complying with the THSteps periodicity schedule. TCHP encourages providers to emphasize the importance of preventive care and assist with scheduling timely care for all patients. Click here to access the HEDIS^® Quick Reference Childhood Immunization Status tool kit. To access all HEDIS Tool Kits click here.

Potential Provider Incentives*: In order to assist and recognize providers who emphasize timely preventive care, providers may be eligible to participate in a Provider Incentive Program, which rewards primary care providers whose patients are compliant with the THSteps periodicity schedule within the first 15 months of life. The program has quarterly payouts and care must be captured administratively through claims.

Providers must qualify to participate in this program based on their panel size and network participation. If you are interested in learning more, please contact your assigned Provider Relations Liaison (PRL). If you are not aware of your assigned PRL, please email providerrelations@texaschildrens.org. We are excited to offer this to our network and encourage your participation.

Health Rewards Program for Member’s: TCHP also has member incentives, known as our Healthy Rewards Program/Value Added Services (VAS) program. The program is renewed annually and became effective on September 1, 2023, and will end on August 31, 2024.

Here is an explanation of the well-child reward program available to members.

• Well-Child Checkup Reward (available to members age 0-15mo)
  • Receive a $50 reward card for completing 3 well-child checkups by the age of 15 months
  • Receive an additional $100 reward card when completing 6 well-child checkups by the age of 15 months
  • Checkups must be coded as well-child visits to qualify (see below)

For information on our entire Healthy Rewards/Value Added Services Program for 2023-2024 please visit our provider alert available here, http://www.thecheckup.org/2023/08/16/provider-alert-healthy-rewards-value-added-services-for-2023-2024/.

We also have rewards in the following categories: healthy pregnancy, health and wellness, healthy play and exercise, and extra help for families.

Go directly to the webpage here, https://www.texaschildrenshealthplan.org/benefits/healthy-rewards.

Next step for Providers: Please schedule all required infant well-child appointments in advance and submit claims as soon as services are rendered. We kindly ask that providers submit claims timely so that they are compliant with the Healthcare Effectiveness Data and Information Set (HEDIS) measures. In doing so, you are continuing to provide great care to our members while also having the opportunity to participate in the Provider Incentive Program. We ask that providers use appropriate codes to reflect the services for infant well-child visits. Additional information on appropriate coding is shown below:

Well-Child Visits in the First 30 Months of Life (W30)

(replaces W15, now also includes ages 15 to 30 months)

1. Assesses children who turned 15 months old during the measurement year and who had at least 6 well-child visits with a PCP during their first 15 months of life.
2. Assesses children who turned 30 months old during the measurement year and who had at least 2 well-child visits with a PCP between 15 and 30 months of life.

Age Range	CPT Codes (new patients)	CPT Codes (established patients)	ICD-10 Diagnosis Codes
0-7 days	99381	99391	Z00.110
8-28 days	99381	99391	Z00.111
29-364 days	99381	99391	Z00.121*, Z00.129 †
12-30 months	99382	99392	Z00.121*, Z00.129 †

* With abnormal findings

† Without abnormal findings.

Please refer to the HEDIS Quick Reference for Well-Child Visits for more information.

Providers are encouraged to share this communication with their staff and implement office management protocols that prioritize scheduling of timely well child care and immunizations. Providers are also encouraged to share education on the importance of timely preventive care with members.

For additional information on the importance of Infant Well-Child Visits, and information to share with patients, providers and staff can visit:

TCHP Infant and Child Health Care Webpage

Texas Health Steps Medical Checkup Periodicity Schedule for Infants, Children and Adolescents

American Academy of Pediatrics – Bright Futures

HealthyChildren.Org – Your Child’s Checkups

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.