TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > Children's Health Insurance Program (CHIP) Perinatal Claims

   
 

6.17 Children's Health Insurance Program (CHIP) Perinatal Claims

Inpatient services under CHIP Perinatal for unborn children and women between zero and 185 percent of the federal poverty level (FPL) will be reimbursed as follows:

For women with income at or below 185 percent FPL:

Hospital facility charges paid through Emergency Medicaid and processed by TMHP.

Professional service charges paid 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 paid through the CHIP Perinatal Program and processed by TMHP.

Professional service charges are paid and processed through CHIP.

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.


Texas Medicaid & Healthcare Partnership
CPT only copyright 2009 American Medical Association. All rights reserved.
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