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Hospital Inpatient Claims for Mother and Baby

Provider Administrative Policy

Policy Date
February 2008
Revised/October 2014
Provider Type(s)


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


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 the Federal Employee Program (FEP).

The newborn or newly adopted child must be added to the member policy prior to submitting a claim. Please verify eligibility at, or by calling Customer Service to verify dependent eligibility.

Natural or adopted newborn child
Group policy - Please ask the member to work with their group administrator to add a newborn within the timeframe outlined in their member contract.

Individual policy - Please ask the member to contact the local district office or their health insurance agent to add the newborn within the timeframe outlined in the member contract.

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

If the adopted child is more than 60 days old at the 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 we receive a claim for a child electronically and we cannot find a membership, and if the age of the child is less than 60 days old from the current date, we will convert this to a paper claim. We will then place the claim in a Newborn file. We will send you an error and message report stating:

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

We will hold these claims up to 60 days and claims must include 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
October 2014 Revised Language clarification
May 2008 Revised Title change/language clarification

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