Wiki NEWBORN CLAIMS

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mmunoz@ihcscv.org said:
DOES ANYONE HAVE ANY SUGGESTIONS? I'M BILLING OUT NEWBORN CLAIMS UNDER MOM INSURANCE BUT FOR SOME REASON MANAGECARE BLUECROSS KEEP REJECTING MY CLAIMS.
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It has been a few years since I have billed newborn claims, but when I did we had to wait until the baby was added to the policy before we could bill. With Michigan Medicaid the baby had to have their own coverage established before the claims could be billed.
 
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mmunoz@ihcscv.org said:
DOES ANYONE HAVE ANY SUGGESTIONS? I'M BILLING OUT NEWBORN CLAIMS UNDER MOM INSURANCE BUT FOR SOME REASON MANAGECARE BLUECROSS KEEP REJECTING MY CLAIMS.
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You may want to reach out to the payer. I know for Michigan Blue Cross the newborn care is generally covered under Mom as long as it is routine care. If the baby is sick then the services need to be billed under the baby.
 
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I work for a Blue Plan myself and although a few of our ERISA self-funded employer groups do cover routine newborn care under the mother for the first 30 or 31 days of life, as long as the newborn is eventually enrolled on the plan, if the newborn is never enrolled in the plan then the previously paid claims are adjusted and any payments made are recouped from future provider reimbursements.

However, on almost every other type individual or group policy we offer the newborn's claims are processed under the newborn based on their eligibility or lack of eligibility, this includes the newborn routine nursery charges and inpatient services after birth. There is a very specific and limited window of time for the parents to submit an application to the insurance company to enroll the newborn and if the parents miss that window then the baby is not eligible to be enrolled in the policy until the next scheduled open enrollment period or if some unrelated reason the family qualifies for a special enrollment period, at which time the family can add just about any eligible family member to the policy, including the newborn who was previously ineligible because the parents missed the deadline to submit an application to enroll the newborn.

I have worked on the payer side for 20 years so if you have any questions you are welcome to DM with any questions you might have. Good luck to you!
 
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