Title: 
Headings:  Eligibility for Newborns:  What Providers Need to Know
Eligibility
 
for
 
Newborns:
  
What
 
Providers
 
Need
 
to
 
Know
 

Eligibility
 
Requirements
 
for
 
Newborns
 

NEWBORN
 
PLAN
 
ASSIGNMENT
 

NEWBORN
 
ENROLLMENT
 
AND
 
TRANSITION
 
OF
 
CARE
 

NCTRACKS
 
INFORMATION
 
ON
 
NEWBORNS
 
FOR
 
PROVIDERS
 

BILLING
 
CONSIDERATIONS
  

HOW
 
WILL
 
NEWBORN
 
CLAIMS
 
BE
 
HANDLED
 
IN
 
THE
 
HOSPITAL
 
IF
 
THE
 
ATTENDING
 
PEDIATRICIAN
 
DOES
 
NOT
 
PARTICIPATE
 
IN
 
THE
 
NEWBORN’S
 
HEALTH
 
PLAN?
 

WHAT
 
IF
 
THE
 
MOTHER
 
IS
 
ELIGIBLE
 
ONLY
 
FOR
 
EMERGENCY
 
PREGNANCY
 
MEDICAID
 
COVERAGE?
    

WHAT
 
IF
 
THE
 
MOTHER
 
IS
 
NOT
 
ELIGIBLE
 
FOR
 
MEDICAID?
 
CAN
 
THE
 
NEWBORN
 
RECEIVE
 
MEDICAID?
 

HOW
 
ARE
 
NEWBORNS
 
ASSIGNED
 
TO
 
A
 
MEDICAID
 
MANAGED
 
CARE
 
HEALTH
 
PLAN?
  
WHEN
 
IS
 
COVERAGE
 
FOR
 
ELIGIBLE
 
NEWBORNS
 
EFFECTIVE?
 


Content: HOW
 
WILL
 
NEWBORN
 
CLAIMS
 
BE
 
HANDLED
 
IN
 
THE
 
HOSPITAL
 
IF
 
THE
 
ATTENDING
 
PEDIATRICIAN
 
DOES
 
NOT
 
PARTICIPATE
 
IN
 
THE
 
NEWBORN’S
 
HEALTH
 
PLAN? Answer: If
 
the
 
attending
 
pediatrician
 
is
 
a
 
participating
 
provider
 
for
 
the
 
newborn’s
 
Medicaid
 
Managed
 
Care
 
health
 
plan,
 
then
 
their
 
services
 
would
 
be
 
considered
 
in-
network. If
 
the
 
attending
 
pediatrician
 
does
 
not
 
participate
 
in
 
the
 
newborn’s
 
Medicaid
 
Managed
 
Care
 
health
 
plan,
 
then
 
the
 
pediatrician’s
 
services
 
would
 
be
 
considered
 
out-
of-network. The
 
services
 
would
 
be
 
subject
 
to
 
that
 
plan’s
 
out-of-network
 
service
 
process
 
(including
 
any
 
applicable
 
prior
 
approval
 
requirements),
 
and
 
the
 
pediatrician
 
would
 
receive
 
no
 
more
 
than
 
90%
 
of
 
the
 
Medicaid
 
Direct
 
fee-for-
service
 
rate
 
for
 
those
 
services. WHAT
 
IF
 
THE
 
MOTHER
 
IS
 
ELIGIBLE
 
ONLY
 
FOR
 
EMERGENCY
 
PREGNANCY
 
MEDICAID
 
COVERAGE? Answer: If
 
the
 
mother
 
is
 
authorized
 
as
 
emergency
 
for
 
labor
 
and
 
delivery
 
as
 
of
 
the
 
newborn’s
 
date
 
of
 
birth,
 
the
 
newborn
 
is
 
automatically
 
eligible. Newborn
 
coverage
 
is
 
authorized
 
at
 
the
 
same
 
time
 
as
 
the
 
mother’s
 
Medicaid. WHAT
 
IF
 
THE
 
MOTHER
 
IS
 
NOT
 
ELIGIBLE
 
FOR
 
MEDICAID?