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 to Section V.F.11, 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 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. 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.
