Billing Change for Newborn Claims
MDHHS has been paying providers through Fee For Service (FFS) Medicaid when billing for newborn claims, even when the mother had coverage through a Medicaid Managed Care Plan at the time of birth. They would then process take backs of those payments on a quarterly basis, because the mother’s plan should have been responsible. MDHHS has decided to no longer handle newborn claims in this manner and recently released a Medicaid Letter (L 15-66) advising of a new edit in their system to identify the mother’s information and will begin to reject these claims as of 12/11/15. Providers should no longer submit through FFS for payment of these claims, they will now need to bill the mother’s Managed Care Plan directly for payment instead.
The official release can be found HERE.