Stay on Track: EPSDT Log Requirements & VFC Re-Enrollment Due August 31, 2026 Timely EPSDT Form Submissions Required After each well-child visit, providers must: • Complete the age-appropriate AHCCCS EPSDT form (or approved EHR equivalent) • Maintain documentation in the medical record • Submit forms to Blue Cross Blue Shield of Arizona Health Choice (not AHCCCS) Forms & Resources: EPSDT Forms & Resources Submit for Faster Processing: • Email: HCHEPSDTCHEC@azblue.com • Fax: (480) 760-4716 Forms can also be mailed to: Blue Cross Blue Shield of Arizona Health Choice Attn: EPSDT Team 8220 N 23rd Ave. Phoenix, AZ 85021 Act Promptly — Do Not Delay Submission EPSDT forms should be submitted as soon as possible after the visit and at least monthly. Delays in submission can: • Impact timely care coordination and member outreach • Delay follow-up on referrals and services • Affect AHCCCS quality reporting and compliance Best Practice: Submit forms shortly after each visit to support timely member care and close gaps quickly. Don’t Delay: Weekly Missed Appointment Logs Support Member Outreach Missed medical and dental appointment logs should be submitted weekly, if possible. Sharing this information allows EPSDT Health Promotion Coordinators to: • Follow up with members and families • Assist with care coordination • Help reschedule missed appointments to keep care on track Access Forms Action Required: 2026 VFC Re-Enrollment Deadline – August 31, 2026 Health care professionals enrolled in the Arizona Vaccines for Children (VFC) Program must complete annual re-enrollment by August 31, 2026 to remain compliant and continue serving pediatric members. Helpful Resources: • View Re-Enrollment Instructions • Download 2026 Provider Cover Letter • Download 2026 Re-Enrollment Provider Guide • AMPM Policy 430 Compliance & Impact Failure to re-enroll by the deadline may result in: • Inactivation from the VFC program for non-compliance • Removal of members under age 18 from your panel • Provider Panel updated to accept members 19 - 99 Providers who are inactivated may be required to submit a new enrollment application and may not be eligible to rejoin the program until one (1) year after the Notice of Action. Take Action Today To avoid disruption to your practice and ensure continued service to pediatric members, please complete your VFC re-enrollment as soon as possible. 6/30/2026 Blue Cross, Blue Shield, and the Cross and Shield Symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. DISCLAIMER | PRIVACY POLICY | AZBLUE.COM | OTHER LANGUAGES | NONDISCRIMINATION NOTICE © 2026 Blue Cross Blue Shield of Arizona, Inc., an independent licensee of the Blue Cross Blue Shield Association. All rights reserved.