Enrollment of Newborns. The PH-MCO must have written administrative policies and procedures to enroll and provide all Medically Necessary services to newborn infants of Members, effective from the time of birth, without delay, in accordance with Section V.F.12, Services for New Members, and Exhibit BB, PH-MCO Recipient Coverage Document. The PH-MCO must receive advance written approval from the Department regarding these policies and procedures. The PH-MCO must notify the Department if there are errors or inconsistencies in the newborn’s MA or PH-MCO eligibility dates per the established procedures found on the Pennsylvania HealthChoices Extranet. For pregnant members, the PH-MCO must make every effort to identify what PCP/pediatrician the mother chooses to use for the newborn prior to the birth, so that this chosen Provider can be assigned to the newborn on the date of birth. The PH-MCO is not responsible for the payment of newborn metabolic screenings.
Enrollment of Newborns. The PH-MCO must have written administrative policies and procedures to enroll and provide all Medically Necessary services to newborn infants of Members, effective from the time of birth, without delay, in accordance with Section V.F.12, Services for New Members, and Exhibit BB, PH-MCO Recipient Coverage Document. The PH-MCO must receive advance written approval from the Department regarding these policies and procedures. The PH-MCO must notify the Department if there are errors or inconsistencies in the newborn’s MA or PH-MCO eligibility dates per the established procedures found on the HealthChoices Intranet. For pregnant members, the PH-MCO must make every effort to identify what PCP/pediatrician the mother chooses to use for the newborn prior to the birth, so that this chosen Provider can be assigned to the newborn on the date of birth. The PH-MCO is not responsible for the payment of newborn metabolic screenings.
Enrollment of Newborns. 2.4.9.1 TennCare-eligible newborns and their mothers, to the extent that the mother is eligible for TennCare, should be enrolled in the same MCO with the exception of newborns that are SSI eligible at birth. Newborns that are SSI eligible at birth shall be assigned to TennCare Select but may opt out and enroll in another MCO.
Enrollment of Newborns. The PH-MCO must have written administrative policies and procedures to enroll and provide all Medically Necessary services to newborn infants of Members, effective from the time of birth, without delay, in accordance with Section V.F.12 of this Agreement, Services for New Members, and Exhibit BB of this Agreement, MCO Recipient Coverage Document. The PH-MCO must receive advance written approval from the Department regarding these policies and procedures. For pregnant members, the PH-MCO must make every effort to identify what PCP/pediatrician the mother chooses to use for the newborn prior to the birth, so that this chosen Provider can be assigned to the newborn on the date of birth. The PH-MCO is not responsible for the payment of newborn metabolic screenings.
Enrollment of Newborns. Newborns and infants who are added to the Case of an adult Enrollee who is the Head of Case and enrolled with Contractor are enrolled as follows:
Enrollment of Newborns. Newborns will not be enrolled in CHC. Newborns will be auto-assigned to the HealthChoices PH-MCO aligned with the mother’s CHC-MCO if available in the Zone where they reside.
Enrollment of Newborns. 49 7. Transitioning Members Between PH-MCOs ............................49 8.
Enrollment of Newborns. The Contractor must have written administrative policies and procedures to enroll and provide all necessary services to newborn infants of Members, effective from the time of birth, without delay, in accordance with Section V.F.11 of this Agreement, Services for New Members, and Exhibit BB of this Agreement, PH-MCO Recipient Coverage Document. The Contractor must receive advance written approval from the Department regarding these policies and procedures. The Contractor is not responsible for the payment of newborn metabolic screenings.
Enrollment of Newborns. All Newborns of Contractor’s Medicaid MCO Members, where the Newborn resides in the same household as the mother, are the Contractor’s responsibility. To assure continuity of care in the crucial first months of the Newborn's life, every effort shall be made by the Department to expedite enrollment of Newborns into the same MCO as the mother. Newborn enrollment for Medicaid MCO Members will occur through the following procedures:
Enrollment of Newborns. All newborns of Medicaid MCO program members, where the newborn resides in the same household as the mother, are the responsibility of the Contractor, unless the mother has specified otherwise prior to delivery. A newborn is defined as a Medicaid eligible beneficiary who is under 365 days of age. To assure continuity of care in the crucial first months of the newborn's life, every effort shall be made by the ContractorSCDHHS to expedite enrollment of newborns into the Contractor's Plan. For Medicaid MCO Program members, the SCDHHS will enroll newborns into the same managed care plan as the mother, for the first ninety (90) calendar days from birth unless otherwise specified by the mother. The newborn will be enrolled in the same managed care plan as the mother through the end of the month in which the ninetieth (90th) day falls. The newborn's effective date will be the first day of the month of birth. The enrollment form will contain a statement that the member understands that a child born into the family unit will be enrolled in the same MCO as the mother unless otherwise specified by the mother. The newborn shall continue to be enrolled with the mother's MCO unless the mother/guardian changes the enrollment. For retro newborns, a break in a newborn’s enrollment could occur between the end of the required 90 days and the next period of enrollment in the Managed Care Plan. This break in enrollment is determined by the date of notification of the newborn to SCDHHS or the date of the creation of the newborn’s eligibility record in MEDS. Newborn enrollment for Medicaid MCO program members will occur through the following procedures:
