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Newborn logic for inbound encounters

March 2024

This template captures the data elements used by various health plans and the California Department of Health Care Services (DHCS) to process inbound newborn encounters. Providers and health centers can use this template to crosswalk their encounter data logic workflows to ensure health plan partners can accurately process encounters related to newborn care.

Author

IHA in partnership with the Health Industry Collaboration Effort (HICE) Encounters Standardization Team

Why use it

The Inbound Encounters Newborn Logic template is intended for Provider Organizations and Delegates that work with claims or encounters. This template shows a holistic view of what requirements health plans are using when reviewing newborn encounters.

Who it’s for

Health care organizations, such as provider organizations and delegates that work with claims or encounters, including Health IT specialists, medical billers, healthcare analysts, and Chief Information Officers, can use this template to improve the throughput of their encounter data submissions.

Key take-aways

This resource is designed to be a template for health care organizations to optimize how they’re submitting newborn encounters to their health plans. It can help you:

  • Facilitate review of inbound newborn logic requirements for industry organizations (health plans and regulators) to identify the potential cause of rejections
  • Be a resource for newborn encounter submission guidelines
  • Provide a reference of 837 fields used for newborn encounter submissions

Have edits or additions for this resource? Please let us know.

IHA’s Resource Hub is made possible through a grant from Health Net, LLC’s Encounter Data Improvement Program.

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