Regulation .27 Newborn Coordinator.
Regulation .27 Newborn Coordinator.LinkCopy Citation
A.
An MCO shall identify a newborn coordinator who shall be available to providers during the MCO's business hours as a contact for concerns related to eligibility and provision of services to newborns.
B.
The newborn coordinator shall provide services for a newborn:
(1)
Whose mother is enrolled in the MCO on the date of the newborn's birth; and
(2)
Who is enrolled or who is autoassigned to the MCO after birth.
C.
The newborn coordinator shall:
(1)
Research and confirm the assignment of an eligible newborn to a managed care organization;
(2)
Interface with the enrollment agent, the Department, the newborn coordinators of other MCOs, and the provider to resolve any eligibility issues involving multiple MCOs;
(3)
Facilitate and confirm the selection of a primary care provider for an eligible newborn;
(4)
Request an MCO ID card for a newborn when necessary;
(5)
Make retroactive PCP enrollments when necessary;
(6)
Facilitate the resolution of claims for services provided to an eligible newborn;
(7)
Provide general guidance to providers and their office staff on newborn-related issues;
(8)
Coordinate with ancillary care providers to facilitate appropriate delivery of care and payment of claims; and
(9)
Coordinate and authorize in-network care when the newborn does not yet appear in EVS or the MCO's system, or out-of-network care when the MCO cannot offer an appropriate in-network provider.