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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 3 STAR Program : 3.2 STAR Client Enrollment : 3.2.2 Enrollment of Newborns

3.2.2
In the STAR Program, newborns are automatically assigned to the STAR MCO the mother is enrolled with at the time of the newborn’s birth for at least 90 days following the date of birth unless the mother requests a plan change as a special condition. The effective date of the newborn’s enrollment is the same as the newborn’s DOB. STAR MCOs are responsible for all covered services provided to newborn members.
There may be a delay of up to several months from the DOB for a newborn to receive a Medicaid client number. Providers should check with each STAR MCO for claim filing requirements for newborns who do not yet have a Medicaid client number.
If the newborn has not yet been assigned a PCP, the Your Texas Benefits Medicaid card will indicate that the client is “Newborn” and instruct the provider to “Call Plan” to inquire about filing a claim.
Refer to:
STAR Example
Enrollments of newborns born to mothers enrolled in STAR are retroactive to the newborn’s date of birth. The following example shows the managed care enrollment date for a newborn:
 
January 3
(retroactive to DOB)
January 3
(retroactive to DOB)

Texas Medicaid & Healthcare Partnership
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