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Hospital Inpatient Claims for Mother and Baby


Provider Administrative Policy

Section
Hospital
Policy Date
February 2008
Status/Date
May 2008
Provider Type(s)
Hospitals  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Hospital Inpatient Claims for Mother and Baby

Blue Cross of Idaho requires a separate individual claim for a mother and a baby for services related to birth and delivery. This applies to all lines of business, including traditional, PPO, managed care and Federal Employee Plan (FEP).

Natural or adopted newborn child
Group policy - A member should be referred to their group to add a child within 60 days from the date of birth if the member would like to continue the child's coverage.

Individual policy - Please refer a member to the local district office or their agent to add the newborn within 60 days from date of birth if the member would like to continue the child's coverage.

The baby must be added to the member policy prior to a claim submission.

Adopted child if more than 60 days old at time of adoption or placement for adoption
If the child has not reached 18 years of age at the time of adoption or placement for adoption, the child will be covered under the policy from and after the date of adoption or placement for adoption for 60 days.

The child must be added to the member policy prior to claim submission.

Please note: If a claim for the newborn or adoptee is received electronically and no membership is found and the age of the patient is 60 days or less from current date, the claim will convert to paper and held in a "NEWBORN" file. You will receive a message on your error and acceptance report stating:

"Membership for?"
"Name?"
"Pending completion of enrollment application - contact customer service."

We will hold these claims up to 60 days and they must have the name of the newborn or adoptee at time of processing.  If the newborn is not added to the policy within 60 days, the claim will be returned to the provider indicating there is no membership for the newborn. Providers must then re-submit their claims to Blue Cross of Idaho after the member has updated his/her file.

Timeframes for some self funded groups vary between thirty and ninety days for membership changes.

BlueCard members/claims are excluded from this process.


Policy History

Date Action Reason
May 2008 Revised Title change/language clarification

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