Newborn Enrollment. 4.1.3.1 All newborns shall be Auto-Assigned by DCH or its Agent to the mother’s CMO plan.
4.1.3.2 The Contractor shall be responsible for notifying DCH or its Agent of any Members who are expectant mothers at least sixty (60) Calendar Days prior to the expected date of delivery. The Contractor shall be responsible for notifying DCH or its Agent of newborns born to enrolled members that do not appear on a monthly roster within 60 days after birth.
4.1.3.3 The Contractor shall provide assistance to any expectant mother who contacts them wishing to make a PCP selection for her newborn and record that selection.
4.1.3.4 Within twenty-four (24) hours of the birth, the Contractor shall ensure the submission of a newborn notification form to DCH or its agent. If the mother has made a PCP selection, this information shall be included in the newborn notification form. If the mother has not made a PCP selection, the Contractor shall Auto-Assign the newborn to a PCP within thirty (30) days of the birth. Auto-Assignment shall be made using the algorithm described in Section 4.1.
2.1. Notice of the PCP Auto-Assignment shall be mailed to the mother within twenty-four (24) hours.
Newborn Enrollment a. The Health Plan shall utilize the unborn activation process to facilitate enrollment and shall be responsible for newborns from the date they are enrolled in the Health Plan.
b. Upon unborn activation, the newborn shall be enrolled in the Health Plan in which his/her mother was enrolled during the next enrollment cycle.
c. Newborn Enrollment shall occur through the following procedures:
(1) Upon identification of an Enrollee's pregnancy, the Health Plan shall immediately notify DCF of the pregnancy and any relevant information known (i.e., due date and gender). The Health Plan must provide this notification by completing the DCF-ES 2039 Form and submitting the completed form to DCF. The Health Plan shall indicate its name and number as the entity initiating the referral. The DCF-ES 2039 form is located on the Medicaid web site: xxxx://xxx.xxxx.xxxxx.xx.xx/Medicaid/Newborn
(2) DCF will generate a Medicaid ID number and the unborn child will be added to the Medicaid file. This information will be transmitted to the Medicaid Fiscal Agent. The Medicaid ID number will remain inactive until after the child is born.
(3) The Health Plan shall comply with all requirements set forth by the Agency or its Agent related to Unborn Activation (see Policy Transmittal 06-02, Unborn Activation Process). To ensure the prompt enrollment of Newborns, the Health Plan shall ensure that the form DCF-ES 2039 (Form 2039) is completed and submitted, via electronic submission, to the local DCF Economic Self-Sufficiency Services Office immediately upon the birth of the child. If the Hospital is not a participating Hospital, the Health Plan must complete and transmit the Form 2039 to DCF. With regard to participating Hospitals, as part of its participating Hospital contract, the Health Plan must include a clause that states whether the Health Plan or the participating Hospital will complete and transmit Form 2039 to DCF for all Newborns.
(4) Upon notification that a pregnant Enrollee has presented to the Hospital for delivery, the Health Plan shall inform the Hospital, the pregnant Enrollee’s attending physician and the newborn’s attending and consulting physicians that the newborn is an Enrollee only if the Health Plan has verified that the newborn has an unborn record on the system that is awaiting activation. At this time the Health Plan shall initiate the Unborn Activation process.
(5) Upon activation, the newborn shall be enrolled in the Health Plan in which his/her mother was ...
Newborn Enrollment. If the mother is enrolled in a BadgerCare Plus HMO at the time of birth, and the child is reported to the certifying agency within 100 days of birth, the newborn will be enrolled in the same HMO as the mother back to the infant’s date of birth. If the mother is not enrolled in a BadgerCare Plus HMO on the date of birth, or the child is not reported to the certifying agency within 100 days, then the newborn will be enrolled following the normal ADD methodology for HMO enrollment if applicable. The newborn will be enrolled the next available enrollment month. Infants weighing less than 1200 grams will be exempt from enrollment if the data submitted to the fiscal agent by the HMO or the provider supports the infant’s low birth weight. If an infant weighs less than 1200 grams, the HMO or provider should check the box on the BadgerCare Plus Newborn Report.
Newborn Enrollment a) All newborn children not in an excluded category shall be enrolled in the MCO of the mother, effective from the first day of the child's month of birth.
b) In addition to the responsibilities set forth in Appendix H, the Contractor is responsible for doing all of the following with respect to newborns:
i) Coordinating with the LDSS the efforts to ensure that all newborns are enrolled in the managed care plan;
ii) Issuing a letter informing parent(s) about newborn child's enrollment or a member identification card within 14 days of the date on which the Contractor becomes aware of the birth;
iii) Assuring that enrolled pregnant women select a PCP for an infant prior to birth and the mother to make an appointment with the PCP immediately upon birth; and
iv) Ensuring that the newborn is linked with a PCP prior to discharge from the hospital, in those instances in which the Contractor has received appropriate notification of the birth prior to discharge.
c) The LDSS shall be responsible for ensuring that timely Medicaid Eligibility determination and enrollment of the newborns is effected consistent with state laws, regulations, and policy and with the newborn enrollment guidelines set forth in Appendix H, Section B of this Agreement.
Newborn Enrollment. A Contract for a Newborn child may be accepted by the Program without a Social Security Number. However, the purchaser must supply the Beneficiary’s Social Security Number or Taxpayer Identification Number within 60 days of Contract acceptance.
Newborn Enrollment. Newborns are automatically eligible for a period of six months and are immediately enrolled with the mother’s MCO. If the child’s mother is not a member at the time of the birth, in a hospital or at home, then the child is enrolled during the next applicable enrollment cycle. The CONTRACTOR is not responsible for care of a child hospitalized during enrollment, until discharge except for newborns born to enrolled mothers.
Newborn Enrollment. The HMO is responsible for newborns who are born to mothers whose enrollment in HMO is effective on or before the date of birth as follows:
14.3.1 Newborns are presumed Medicaid eligible and enrolled in the mother's HMO for at least 90 days from the date of birth.
14.3.l.1 A mother of a newborn Member may change plans for her newborn during the first 90 days by contacting TDH Customer Services. TDH will notify HMO of newborn plan changes made by a mother when the change is made by TDH Customer Services.
14.3.2 HMO must establish and implement written policies and procedures to require professional and facility providers to notify HMOs of a birth of a newborn to a Member at the time of delivery.
14.3.2.1 HMO must create a proxy ID number in the HMO's Enrollment/Eligibility and date of birth of the newborn.
14.3.2.2 HMO must match the proxy ID number and the State-issued Medicaid ID number once the State-issued Medicaid ID number is received.
14.3.2.3 HMO must submit a Form 7484A to DHS Data Control requesting DHS Data Control to research DHS's files for a Medicaid ID number if HMO has not received a State-issued Medicaid ID number for a newborn within 30 days from the date of birth. If DHS finds that no Medicaid ID number has been issued to the newborn, DHS Data Control will issue the Medicaid ID number using the information provided on the Form 7484A.
14.3.3 Newborns certified Medicaid eligible after the end of the sixth month following the date of birth will not be retroactively enrolled to an HMO, but will be enrolled in Medicaid fee-for-service. TDH will manually reconcile payment to the HMO for services provided from the date of birth for all Medicaid eligible newborns as described in Article 13.5.4.
Newborn Enrollment. A Contract for a Newborn child may be accepted by the Program until June 30th of the calendar year of the close of an Open Enrollment period. First payments are due within 60 days of acceptance of the Contract by the Program on a date determined by the Program.
Newborn Enrollment a) All newborn children not in an excluded category shall be enrolled in the MCO of the mother, effective from the first day of the child's month of birth.
Newborn Enrollment. Within six (6) months of a child's date of birth, the MCO must notify the DEPARTMENT of newborns for which they have not received enrollment notification from the DEPARTMENT. The MCO shall use the notification form made available by the DEPARTMENT for this purpose. Should the MCO fail to report the child's birth, the MCO shall reimburse the DEPARTMENT for any fee-for-service claims paid for covered services that occurred for the newborn Members prior to processing the newborn's enrollment into the MCO.
