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6.17 Children's Health Insurance Program (CHIP) Perinatal Claims
Claims for services provided to CHIP Perinatal Program clients are submitted to and considered for reimbursement as follows:
For women with income at or below 185 percent FPL:
• Hospital facility charges are paid through Emergency Medicaid and processed by TMHP.
•Professional service charges are paid through the CHIP Perinatal Program and processed through CHIP.
Note: Delivery-related professional services claims denied by the CHIP Perinatal health plan will be considered for reimbursement through Emergency Medicaid and will require the CHIP Perinatal health plan denial notice. These claims should be submitted through the existing Medicaid appeals process within 95 days from the date of the CHIP Perinatal Health plan denial notice. The provider must provide a copy of the complete explanation of benefits that includes the complete description of the reason for denial.
For newborns with a family income at or below 185 percent FPL:
•Hospital facility charges are paid through Medicaid and processed by TMHP
•Professional service charges are paid through Medicaid and processed by TMHP.
Inpatient services (limited to labor with delivery) for unborn children and women with income between 186 and 200 percent of FPL will be covered under CHIP Perinatal, and these claims will be paid by the CHIP Perinatal health plan.
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