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Accurately submitting newborn encounters

July 2023

Since newborns are not immediately assigned their Client Index Number (CIN) at birth, the California Department of Health Care Services (DHCS) has a policy to support filing claims and encounters for newborn services under the mother’s CIN for a set amount of time. The document details the time frame and guidance available on appropriately submitting a newborn encounter when they are not enrolled yet. The resource also includes an example of how to code the encounter when the newborn is not enrolled with a health plan yet.

Author

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

Why use it

Billing services for newborns can be nuanced when they don’t have a CIN assigned yet. Improper coding can result in rejections due to incorrect formatting, member ID placement, or being flagged as a duplicate of another encounter. Readers will find DHCS guidance on how long newborns can be billed under their mother’s CIN (newborn’s birth month and the following month) and instructions on how to code those encounters.

Though instructions exist from the regulator and health plan level, this document is meant to clearly detail the guidance and provide an industry-curated example of how to code for newborn encounters.

Who it’s for

This resource is intended for all provider organizations (Managed Services Organizations, provider practices, Independent Physician Associations, etc) that submit encounter data, particularly those that participate in Medi-Cal.

Key take-aways

Under DHCS policy, a newborn can be billed under the mother’s CIN for their birth month and the following month. Provider organizations should adhere to the DHCS policy to ensure timely and complete encounter data quality in Medi-Cal. The following recommended actions also support accurate newborn submissions:

  • All Medi-Cal Managed Care Plans (MCPs) should review and update their guidance to comply with the DHCS policy for newborn submissions. MCPs should share and communicate the guidance with their contracted providers.
  • Consistent formatting requirements for providers would help streamline the submission process. This resource provides an example and description of an industry-backed best practice on submitting newborn services when a newborn isn’t enrolled in Medi-Cal.

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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