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: CAN
 
THE
 
NEWBORN
 
RECEIVE
 
MEDICAID? Answer: A
 
newborn
 
whose
 
mother
 
does
 
not
 
qualify
 
for
 
Medicaid
 
may
 
still
 
qualify
 
independently. In
 
this
 
situation,
 
an
 
application
 
for
 
Medicaid
 
coverage
 
must
 
be
 
submitted
 
for
 
the
 
newborn
 
with
 
the
 
appropriate
 
DSS
 
office. HOW
 
ARE
 
NEWBORNS
 
ASSIGNED
 
TO
 
A
 
MEDICAID
 
MANAGED
 
CARE
 
HEALTH
 
PLAN? WHEN
 
IS
 
COVERAGE
 
FOR
 
ELIGIBLE
 
NEWBORNS
 
EFFECTIVE? Answer: Enrollment
 
with
 
a
 
health
 
plan
 
will
 
be
 
retroactive
 
to
 
the
 
first
 
day
 
of
 
the
 
month
 
of
 
birth. Health
 
plan
 
assignment
 
will
 
be
 
based
 
on
 
the
 
mother’s
 
choice
 
or
 
the
 
auto
 
assignment
 
algorithm. If
 
the
 
mother
 
is
 
enrolled
 
with
 
a
 
health
 
plan,
 
the
 
newborn
 
would
 
be
 
assigned
 
to
 
the
 
mother’s
 
plan.