7.2.3.2 Enrollment of Pregnant Women (Type Program 40)Women who are on Medicaid type program 40 may be retroactively enrolled in STAR. Women who are certified for Medicaid type program 40 on or before the 10th of the month will be enrolled in STAR beginning the first of the month of certification. Those who are certified after the 10th of the month will be on fee-for-service the month of certification and will be enrolled in STAR beginning the first of the month following the month of certification. There are two exceptions to this rule:
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• It is important that providers call the number listed on the Medicaid Identification Form (Form H3087) for plan and provider information. Example 1: Woman Certified in Her 6th Month
Example 2: Woman Certified in Her 6th Month
Example 3: Woman Certified in Her 9th Month
A pregnant woman who is on type program 40 has 16 days from the date of application to choose a STAR health plan. If she does not choose a STAR health plan, one will be chosen for her. Expedited Medicaid Managed Care Enrollment for Pregnant Women The enrollment broker contacts the client to begin the enrollment process and assists the client in selecting an HMO. The client may also contact the enrollment broker directly at 1-800-964-2777 (STAR Help Line). To protect continuity of care and client choice, the enrollment broker will work with each pregnant woman to select a health plan that includes her current prenatal care provider or to choose an obstetrical care provider that meets her needs. Until coverage begins in a Medicaid Managed Care Program, clients will be covered under traditional Medicaid fee-for-service. Clients may initially receive a Medicaid Identification Form (Form H3087) that shows them to be a client of a STAR health plan but does not list the plan name. To ensure proper billing, providers should call the enrollment broker at 1-800-964-2777 (STAR Help Line) to obtain the name of the client's health plan. The health plan name should appear on the Medicaid Identification Form (Form H3087) the following month. However, client eligibility should always be verified. Within 14 days of enrolling in a new health plan, a plan representative will contact the new client to help arrange the first prenatal appointment. Physicians should also expect contact from the health plans to facilitate prenatal appointments for new clients. Physicians and other prenatal care providers are encouraged to make prenatal appointments within two weeks. Enrollment of Newborns STAR health plans are responsible for all covered services provided to newborn clients. In the STAR Program, newborns are automatically assigned to the STAR health plan the mother is enrolled with 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. In the STAR+PLUS Program, newborns are enrolled in the STAR plan offered by the mother's STAR+PLUS plan, if available. If the STAR+PLUS plan does not also provide STAR services in the SA, the newborn is automatically enrolled in traditional Medicaid until the mother selects a STAR plan for the newborn. As with the traditional Medicaid program, there may be a delay of up to several months from the date of birth (DOB) for a newborn to receive a Medicaid client number. Providers should check with each STAR health plan for claim filing requirements. If the newborn has not yet been assigned a primary care provider, the Medicaid Identification Form (Form H3087) will indicate that the client is "Newborn" and instruct the provider to "Call Plan" to inquire about filing a claim. Refer to: "Newborn Claims Submission" and "STAR+PLUS Program" . Timely Notification and Assignment of Medicaid ID for Newborns Hospitals that submit their birth certificate information utilizing the DSHS, Bureau of Vital Statistics (BVS) electronic Certificate Manager software and the HHSC Form 7484, receive a rapid and efficient assignment of a newborn Medicaid identification number. This process expedites reimbursement to hospitals and other providers involved in newborn care. Call 1-512-458-7367 for further questions or comments about this process. |
Women who are certified at any time in their estimated month of delivery will be enrolled in STAR the first of the following month (prospective enrollment).
