Date: November 7, 2019
To: Enrolled Hospitals; Physicians; and Advanced Practice Nurses
Re: Practitioner Newborn Claim Submission to HealthChoice Illinois Managed Care Plans
This notice outlines a process for physicians and advanced practice nurses to submit claims for newborns when the baby has not yet been assigned a recipient identification number (RIN). This process applies only to newborns whose mothers are covered under a HealthChoice Illinois managed care plan.
A new system is in place for hospitals to notify the Department of a newborn’s birth through the Application for Benefits Eligibility (ABE) Partner Portal. This system is explained in detail in provider notices to hospitals dated June 25, 2019 and September 6, 2019. It is anticipated this system will significantly reduce the time involved in getting a child added for coverage.
However, to help alleviate the problem of timely claim filing issues, until a newborn is assigned a RIN and added to the mother’s managed care plan, practitioners should submit their newborn claims to the mother’s managed care plan under the mother’s RIN. The managed care plans will deny these claims; however, providers can use their denied claims to track newborns awaiting RINs and then submit a corrected claim once the newborn RIN is assigned. The rejection date will be considered in any timely filing issue.
Providers are reminded of the following billing policy:
Ø For newborns who are added to Medicaid less than 46 days from the date of birth:
· The newborn’s eligibility date and birth date will be the same
· If the mother is enrolled with the MCO on the newborn's date of birth, the newborn will be assigned to the same MCO and the newborn’s MCO eligibility will be retroactive to the newborn's date of birth
· Services are to be billed to the MCO
Ø For newborns who are added to Medicaid 46 days to 364 days from date of birth:
· The mother is currently assigned to an MCO
· The infant will be assigned to the mother’s MCO prospectively
· Services provided from the newborn's date of birth until the date of MCO eligibility should be billed to HFS as fee-for-service
· Services provided from the date of MCO eligibility forward can be billed to the MCO
Providers should check MEDI for eligibility any day after day 46 to verify where claims should be directed (MCO or HFS).