TMPPM 2008 > Provider Information > Managed Care > STAR Program

7.2.6.1 Newborn Claims Submission

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. Claims for services provided to newborns should be filed with the mother's STAR health plan. Providers filing claims for services provided to newborns are still responsible for meeting the Medicaid filing deadlines, which in most cases is within 95 days of each date of service.

HMO Newborn Claims Filing

Claims for newborns who are clients of an HMO should be filed directly with the client's HMO.

Health-care providers should file newborn claims using the newborn's Medicaid identification number as soon as it is made available to them.

HMOs must pay providers for inpatient and professional services related to neonatal care for up to 48 hours after vaginal delivery and 96 hours after cesarean delivery. (Prior authorizations and primary care provider assignment cannot be a reason for denial of claims.)

HMOs may require prior authorizations for hospital and professional services beyond the 48/96 hour time limits.

Authorization requests, utilization review questions, and claim status inquiries and appeals should be directed to the STAR health plan in which the client is enrolled.

Note: Telephone numbers and addresses for claims submission and appeals for STAR HMOs can be found in the appropriate HMO provider policies and procedures manual for the appropriate SA.

Refer to: "Claims Filing Information" for information about claims filing for STAR+PLUS.

"Claims Filing Information" for information about claims filing for NorthSTAR.