TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > TMHP Electronic Claims Submission > Electronic Rejections > Newborn Claim Hints

   
 

6.2.3.1 Newborn Claim Hints

The following are to be used for newborns:

If the mother's name is "Jane Jones," use "Boy Jane Jones" for a male child and "Girl Jane Jones" for a female child.

Enter "Boy Jane" or "Girl Jane" in first name field and "Jones" in last name field. Always use "boy" or "girl" first and then the mother's full name. An exact match must be submitted for the claim to process.

Do not use "NBM" for newborn male or "NBF" for newborn female.

The following are the most common reasons for electronic hospital UB-04 CMS-1450 claim rejections:

Admit hour outside allowable range (such as 24 hours).

Billed amount blank.

Health coverage ID blank or invalid. This number must be the valid nine-digit Medicaid client number. Incorrect data includes: a number less than nine digits; PENDING; 999999999; and Unknown.

Referring physician information on outpatient claim is blank when laboratory/radiology services are ordered or a surgical procedure is performed. The referring physician's NPI is required in Fields 78-79. Consult the software vendor for the location of this field on the electronic claims entry form.

Refer to: Subsection 8.6, "PCCM" in Section 8, "Managed Care" (Vol. 1, General Information)


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