Newborn Infant using Mother's ID

Coverage set up in Registration

It is recommended to first check the benefits tab. Ensure that there are no other insurances on file that Medi-Cal may not reflect to avoid denials due to Coordination of Benefits. If the patient has a non-Medi-Cal ID, please bill the commercial insurance as primary and Medi-Cal as secondary.

The Newborns' and Mothers' Health Protection Act of 1996 (Newborns' Act) 

This act protects mothers and newborns by requiring group health plans to cover a minimum length of hospital stay after childbirth. They are cover by this act the month of and the month after.

1. Add a New or Existing Window will pop up in EPIC, Who is the subscriber coverage? (person responsible for the insurance) Please provide the name of the mother. (The father's name should not be added as the responsible parent during the month and month after even if the father is the policy holder)
2. Relationship to Subscriber - Other Relationship (TYPE -100)
3. Dependent Type- Child dependent (Type-1)
4. Add Effective to when the coverage is over. (Example if the child is born 01/01/2024 the effective date is 02/30/2024)
5. Recipient No - MOTHER'S MEMBER ID
6. Subscriber Name -MOTHER'S LAST NAME, FIRST NAME

Ensuring the accuracy of the effective date is crucial as it informs us of the expiration of the mother's member ID. This prompts us to take necessary action for the next visit and to consider adding the child to the mother's or father's insurance policy. It's important to note that this action will automatically terminate the effective dates. Also that no feature claims will not be tied to mother's ID

What can potentially happen if you choose the wrong relationship to subscriber.

SELF: The claim will be printed with the mother's name as the patient, potentially resulting in a denial.

CHILD: The insurance will flag it as the child being added and covered under the mother's policy and deny the charges due to lack of eligibility and coverage under the policy.

NO ELIGIBILITY, NOT COVER UNDER POLICY.

CCS- California Children's Services

We must bill mother's Medi-cal policy prior to sending any claims to CCS although the child has a CCS and it is active Medi-cal. Most likely the the claim will get denied due to No active coverage. Even if the Medi-cal is reflecting active coverage.

Note: you can add CCS as secondary and put the active coverage after mother's termination date.

EXAMPLE: Child was born 01/01/2024 that means the child has active coverage through mother's policy on 01/01/2024-02/30/2024. CCS coverage will start 03/01/2024

This will assist with futures appointments and will let verifiers known that they have CCS coverage on the next follow up.

It is important to refrain from deleting any policies. Please add termination date and add the new coverage. Deleting coverage may result in the deletion of other claims associated with that coverage. This could lead to denials or payment posting errors, ultimately causing significant disruption.

CMS 1500

Clean Claim

Epic Registration to set up mother's Information to Reflect this Image.

Updated on: 11/14/2024 DP