21.3.2 Newborn Eligibility Process for FQHCsA child is deemed eligible for services provided by the Texas Medicaid Program for up to one year if the mother is receiving services provided by the Texas Medicaid Program at the time of the child's birth, and if the child continues to live with the mother, and if the mother continues to be eligible for Medicaid or would be eligible for Medicaid if she were pregnant. Therefore, it is not acceptable to require a deposit for newborn care from a Medicaid client. The child's eligibility ceases if the mother relinquishes her parental rights or if it is determined that the child is no longer part of the mother's household. Filing a claim for a newborn client under the mother's client number can delay a claim payment. Note: When billing for a Medicaid Managed Care client, providers must adhere to the client's health plan's guidelines for newborn billing. Claims with charges for newborn care are submitted separately from charges for the mother. Claims submitted for services provided to a newborn child should be filed using the newborn child's Medicaid number. To expedite the claims processing, enter the mother's name in Block 84 of the Remarks field of the UB-04 CMS-1450 claim form. Include this information in Block 4 of the CMS-1500. To provide information about each child born to a mother eligible for Medicaid, FQHCs with birthing centers should complete Form 7484 Hospital Report of Newborn Child or Children. If the newborn's name is known, include it on the form. The use of Baby Boy or Baby Girl delays the assignment of a number. Filing this form expedites the assignment of a Medicaid number for the newborn child. Do not complete this form for stillbirths. Refer to: "Hospital Report (Newborn Child or Children) HHSC Form 7484" on page B-49. The FQHC should complete the form within five days of the child's birth and send it to DSHS. This five-day time frame is not mandatory; however, prompt submission will expedite the process of determining the child's eligibility. FQHCs should duplicate the form as needed because HHSC and TMHP do not supply this form. Upon receipt of a completed form, DSHS verifies the mother's eligibility and sends notices within ten days to the hospital or birthing center, attending physician (if identified), mother, and caseworker. The notice includes the child's Medicaid number and the effective date of coverage. HHSC will issue a client Medicaid Identification form (Form H3087) after the child has been added to the eligibility file. The attending physician's notification letter is sent to the address on file for the license number at the Texas Medical Board. This address must be kept current to ensure timely notification of attending physicians. Physicians should submit address changes to the following address:
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Texas Medicaid & Healthcare Partnership CPT only copyright 2007 American Medical Association. All rights reserved. |
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