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. 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.
2.4.9.2 A newborn may be inadvertently enrolled in an MCO different than its mother. When such cases are identified by the CONTRACTOR, the CONTRACTOR shall immediately report to TENNCARE, in accordance with written procedures provided by TENNCARE, that a newborn has been incorrectly enrolled in an MCO different than its mother.
2.4.9.3 Upon receipt of notice from the CONTRACTOR or discovery by TENNCARE that a newborn has been incorrectly enrolled in an MCO different than its mother, TENNCARE shall immediately:
2.4.9.3.1 Disenroll the newborn from the incorrect MCO;
2.4.9.3.2 Enroll the newborn in the same MCO as its mother with the same effective date as when the newborn was enrolled in the incorrect MCO;
2.4.9.3.3 Recoup any payments made to the incorrect MCO for the newborn; and
2.4.9.3.4 Make payments only to the correct MCO for the period of coverage.
2.4.9.4 The MCO in which the newborn is correctly enrolled shall be responsible for the coverage and payment of covered services provided to the newborn for the full period of eligibility. Except as provided below, the MCO in which the newborn was incorrectly enrolled shall have no liability for the coverage or payment of any services during the period of incorrect MCO assignment. TENNCARE shall only be liable for the capitation payment to the correct MCO.
2.4.9.5 There are circumstances in which a newborn’s mother may not be eligible for participation in the TennCare program. The CONTRACTOR shall be required to process claims received for services provided to newborns within the time frames specified in Section 2.22.4 of this Agreement. A CONTRACTOR shall not utilize any blanket policy which results in the automatic denial of claims for services provided to a TennCare-eligible newborn, during any period of enrollment in the CONTRACTOR’s MCO, because the newborn’s mother is not a member of the CONTRACTOR’s MCO. However, it is recognized that in complying with the claims processing time frames specified in 2.22.4 of this Agreement, a CONTRACTOR may make payment for services provided to a TennCare-eligible newborn enrolled in the CONTRACTOR’s MCO at the time of payment but the newborn’...
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. 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 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. 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:
4.6.1 When an Enrollee gives birth and the newborn is added to the Case before the newborn is forty‐five (45) days old, the newborn is automatically enrolled with Contractor. Contractor shall provide coverage of the newborn Enrollee retroactively to the date of birth.
4.6.2 When an Enrollee gives birth and the infant Potential Enrollee is added to the Case when the infant Potential Enrollee is over forty‐five (45) days old but less than one (1) year old, the infant Potential Enrollee is automatically enrolled with Contractor. Enrollment shall be prospective as provided in section 4.7.
Enrollment of Newborns. Babies born to women enrolled in Medicaid (excluding Package C) are automatically eligible for Medicaid benefits for one year from the baby’s date of birth. If the woman is enrolled in an MCE on the newborn’s date of birth, the baby is assigned to the woman’s MCE, retroactive to the baby’s date of birth, assuming the availability of an appropriate PMP for the newborn. The MCE will receive the newborn's monthly capitation rate retroactively from the newborn’s date of birth once eligibility for the newborn is established and the baby is enrolled with the MCE. The State fiscal agent will notify the mother in writing of the auto-assignment of the newborn. If the newborn is not assigned to the mother’s MCE due to the lack of pediatric panels slots in the mother’s MCE, the newborn will remain in fee-for-service until the effective date of an assignment to another MCE. In these cases, claims for services from the baby’s date of birth until assignment to an MCE will be the responsibility of the State fiscal agent on a fee-for- service basis. The Hoosier Healthwise program encourages all pregnant women to select a PMP for their child prior to the birth of their baby. A mother must choose a PMP for her unborn child from the MCE in which she is enrolled. Newborns of women in Package C are not automatically eligible for the benefits. If a woman who is enrolled in Package C becomes pregnant, she must submit an application for Health Coverage for her newborn. FSSA must determine if the newborn is eligible for Medicaid or CHIP. If eligible for Hoosier Healthwise Package C (CHIP), the member must pay the Hoosier Healthwise Package C (CHIP) premium before the newborn is enrolled in the program. Once the State receives the first Hoosier Healthwise Package C (CHIP) premium payment, the newborn is eligible for benefits. The State will assign the newborn prospectively to an MCE either by selection or auto-assignment. The Hoosier Healthwise MCE Policies and Procedures Manual provides more information regarding the Pre-Birth Selection and MCE selection and change process.
Enrollment of Newborns. 51 7. Transitioning Members Between PH-MCOs......................................................51 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. Babies born to women enrolled in HIP are automatically eligible for Medicaid benefits for one year from the baby’s date of birth. If the woman is enrolled in an MCE on the newborn’s date of birth, the baby is assigned to the woman’s MCE, retroactive to the baby’s date of birth, assuming the availability of an appropriate PMP for the newborn. The MCE will receive the newborn's monthly capitation rate retroactively from the newborn’s date of birth once eligibility for the newborn is established and the baby is enrolled with the MCE. The State fiscal agent will notify the mother in writing of the auto-assignment of the newborn. If the newborn is not assigned to the mother’s MCE due to the lack of pediatric panels slots in the mother’s MCE, the newborn will remain in fee-for-service until the effective date of an assignment to another MCE. In these cases, claims for services from the baby’s date of birth until assignment to an MCE will be the responsibility of the State fiscal agent on a fee-for- service basis. The HIP MCE Policies and Procedures Manual provides more information regarding the Pre-Birth Selection and MCE selection and change process.
