July 2022

Catch Up on Routine Vaccines and Well-Child Visits

The COVID-19 pandemic disrupted routine childhood immunizations and well-child visits for many people, according to the Centers for Disease Control and Prevention (CDC). The CDC recommends that doctors and health care professionals encourage families to schedule vaccines and visits to help children catch up. We’ve created Wellness Guidelines and vaccine information for our members to boost awareness.

Closing Care Gaps
To help monitor and improve our members’ care, we track these Healthcare Effectiveness Data and Information Set (HEDIS^®) measures developed by the National Committee for Quality Assurance:

Child Immunization Status tracks the percentage of 2-year-olds who received by their 2nd birthday a total of:

Four diphtheria, tetanus and acellular pertussis (DTaP)
Three polio (IPV)
One measles, mumps and rubella (MMR)
Three haemophilus influenza type B (HiB)
Three hepatitis B (Hep B)
One chicken pox (VZV)
Four pneumococcal (PCV)
One hepatitis A (Hep A)
Two or three rotavirus (RV); all doses should be given before 8 months of age
Two flu vaccines

Immunizations for Adolescents tracks the percentage of 13-year-olds who received by their 13th birthday:

One dose of meningococcal vaccine
One tetanus, diphtheria and pertussis (Tdap)
The complete human papillomavirus vaccine (HPV) series

Well-Child Visits in the First 30 Months of Life measures the percentage of children who had:

Six or more well-child visits with a primary care physician during their first 15 months
Two or more well-child visits during their next 15 months

Tips to Consider

Consider identifying members who have missed vaccines or well-child visits. You can also consider contacting their caregivers to schedule appointments.
Check for any missing immunizations at each visit. Address common misconceptions about vaccines.
To document well-child visits. Note that the visit was with a primary care physician (PCP) and include these details in the medical record:

Date of visit
Health history
Physical and mental development history
Physical exam
Health education or anticipatory guidance

We collect immunization data through claims and chart review. To document immunizations, you may include in the medical record any of the following:

Certificates of immunizations
Diagnostic reports
Subjective, Objective, Assessment and Plan (SOAP) notes
Office or progress notes

Resources

CDC recommendations on COVID-19 vaccines and boosters for children and teens
BCBSIL preventive care guidelines on immunization schedules

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

Information provided by BCBSIL is for informational and educational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with BCBSIL. Any samples in this communication are for illustrative and/or educational purposes only and should not be relied on in determining how a specific Provider will be reimbursed. In the event of a conflict between the information in this presentation and your contract, your contract will control.

The information provided does not constitute coding or legal advice. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment.

HEDIS is a registered trademark of NCQA.