TMPPM 2009 > Provider Information > Managed Care > PCCM

7.7.21.1 PCCM Newborn Claims Filing

PCCM newborns are automatically assigned to the PCCM at the time of the newborn's birth. The effective date of the newborn's enrollment is the same as the newborn's date of birth. Claims filing procedures for PCCM newborns will continue to be handled under Texas Medicaid fee-for-service billing guidelines through TMHP.

Health care providers should file newborn claims using the newborn's Medicaid Identification number as soon as it is made available to them. A referring provider identifier is not required when submitting claims for clients who have PCCNEWB01 on their Medicaid Identification Form (Form H3087). Any Medicaid provider can see the newborn. Claims submitted for newborns will be accepted even if a primary care provider has not been selected or assigned. Parents of a newborn have up to 105 days to select a primary care provider for their baby. If parents do not select a primary care provider, a primary care provider is selected for the newborn on the basis of claims history.

Once the baby is assigned a primary care provider and a Medicaid number, normal billing and referral procedures will be in effect.

Refer to: "CMS-1500 Instruction Table" Referring Physician field (boxes 17a and 17b) for specific services that require a referring provider number.