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: An
 
application
 
must
 
be
 
submitted
 
for
 
the
 
child
 
and
 
the
 
child
 
must
 
meet
 
all
 
eligibility
 
requirements,
 
including
 
income. The
 
local
 
county
 
department
 
of
 
social
 
services
 
determines
 
eligibility
 
the
 
same
 
as
 
for
 
any
 
Medicaid
 
applicant. All
 
information
 
contained
 
in
 
this
 
document
 
is
 
dependent
 
upon
 
the
 
actual
 
NC
 
Medicaid
 
or
 
NC
 
Health
 
Choice
 
status
 
and
 
managed
 
care
 
status
 
of
 
the
 
newborn. Nothing
 
in
 
this
 
document
 
supersedes
 
the
 
newborn’s
 
actual
 
official
 
status
 
according
 
to
 
the
 
records
 
of
 
the
 
NC
 
Department
 
of
 
Health
 
and
 
Human
 
Services,
 
Division
 
of
 
Health
 
Benefits. NEWBORN
 
PLAN
 
ASSIGNMENT
 
If
 
on
 
the
 
date
 
she
 
gives
 
birth,
 
the
 
mother
 
is
 
covered
 
by…
 

Newborn
 
is
 
covered
 
by…
 

Medicaid
 
Direct
 

Managed
 
Care
 
Health
 
Plan
 

Medicaid
 
Managed
 
Care
 
Health
 
Plan
 

Managed
 
Care
 
Health
 
Plan
 

NEWBORN
 
ENROLLMENT
 
AND
 
TRANSITION
 
OF
 
CARE
 
Q: What
 
data
 
will
 
health
 
plans
 
receive
 
to
 
support
 
newborn
 
enrollment
 
and
 
when
 
will
 
they
 
receive
 
it? What
 
Transition
 
of
 
Care
 
supports
 
are
 
required? A: Health
 
plans
 
will
 
receive
 
newborn
 
enrollment
 
information
 
once
 
the
 
county
 
DSS
 
enters
 
the
 
newborn’s
 
eligibility
 
in
 
NC
 
FAST. The
 
health
 
plans
 
receive
 
enrollment
 
information
 
daily.