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CHIP Perinatal-Labor with Delivery Changes. Form H3038. Objective. Participants will be able to describe the new process used to cover the labor and delivery costs for eligible CHIP perinatal mothers. Eligibility.

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Presentation Transcript
objective
Objective

Participants will be able to describe the new process used to cover the labor and delivery costs for eligible CHIP perinatal mothers.

eligibility
Eligibility
  • CHIP Perinatal covers the unborn child of low income uninsured women, including women who do not meet citizenship requirements and who do not qualify for Medicaid.
  • Many women must obtain Emergency Medicaid to cover the cost of labor with delivery.
health plan pays all costs
Health Plan Pays All Costs
  • For women with income above 185% and at or below 200% of the federal poverty income limits (FPIL), the CHIP perinatal health plan pays:
    • All hospital facility covered costs, and
    • All covered professional charges.
  • Emergency Medicaid is not required for payment of labor with delivery cost.
health plan billing
Health Plan Billing

The health plan identification card shows billing to the health plan for both Professional/Other Services Billing and Hospital Facility Billing.

Back

Front

emergency medicaid needed
Emergency Medicaid Needed
  • The CHIP perinatal health plan pays for all covered professional charges for women with income at or below 185% of the FPIL.
  • Medicaid pays for all covered hospital facility charges for women with income at or below 185% of the FPIL who obtain Emergency Medicaid for labor with delivery.
tmhp billing
TMHP Billing

The health plan identification card for women with income at or below 185% of the FPIL have contact information for the Texas Medicaid Health Partnership (TMHP) listed for hospital billing.

Back

Front

stream lined emergency medicaid
Stream Lined Emergency Medicaid

New Process

CHIP perinatal clients with income at or below 185% of the FPIL are no longer required to complete a new application to apply for EmergencyMedicaid for labor with delivery.

  • The initial CHIP perinatal application and supporting verification documents are used to determine eligibility for Emergency Medicaid for labor with delivery.
enrollment confirmation
Enrollment Confirmation

New Process Continued

CHIP Administrator mails mothers who are eligible for CHIP perinatal coverage with income at or below 185% of the FPIL a:

  • Enrollment Confirmation Notice,
  • Bar coded Emergency Medical Services Certification Form H3038, and
  • Self-addressed postage paid envelop.
bar coded image
Bar Coded Image

The bar code is located at the bottom of the Emergency Medical Services Certification, Form H3038 that is sent to the eligible CHIP Perinatal mother.

emergency certification form h3038
Emergency Certification Form H3038

If the Form H3038 has not been received by the State, one month before the expected delivery due date CHIP Administrator sends the mother a:

  • Second bar coded Emergency Medical Services Certification Form H3038,
  • Self-addressed postage paid envelop, and
  • Birth Outcome Letter
completing the form
Completing the Form

The physician who delivers the baby typically completes the Emergency Medical Services Certification Form H3038, at the time of delivery.

  • Bar coded Form H3038 or
  • Regular Form H3038
submitting the form
Submitting the Form

Hospital staff can return the completed form by:

  • Fax to 1-877-542-5951, or
  • Submitting it to an out-stationed eligibility worker, or
  • Mail to: HHSC

PO Box 14400

Midland, TX 78711-4400)

bar coded h3038
Bar Coded H3038

The advantage of returning the bar coded Emergency Medical Services Certification, Form H3038 is it allows automated linking between Form H3038 and the CHIP perinatal case in the eligibility system.

forgetting the bar coded form
Forgetting the Bar-Coded Form
  • The standard Form H3038 without the individual bar coding can be used when the mother forgets to provide the bar coded form at the time of delivery.
  • When a non-coded form is used, the mother’s CHIP perinatal ID number must be written on the top of the form.
birth reminder letter
Birth Reminder Letter

One month following the expected due date, if HHSC has not received a Emergency Medical Services Certification Form H3038, the mother will receive:

  • A final bar coded Emergency Medical Services Certification Form H3038,
  • Self-addressed postage paid envelop, and
  • A Birth Reminder Letter.
verifying coverage
Verifying Coverage

Verifying PCN/Medicaid number for mom and baby (185% FPL and below):

  • Look on TMHP web portal: www.tmhp.com
  • Call TMHP help line for assistance: 1-800-925-9126
verifying coverage18
Verifying Coverage

Options for verifying CHIP perinatal eligibility:

  • Have client contact 1-877-KIDS-NOW.
  • Contracted health plan providers who have an online account may be able to verify eligibility by using the health plan’s website.
  • Contact health plan by calling plan’s provider hotline
failure to return form h3038
Failure to Return Form H3038

If Emergency Medical Services Certification Form H3038 is not received within 30 days of the date on the Birth Outcome Reminder Letter, a new Application for Assistance is required and program eligibility must be determined based on the new information provided.

resources hhsc websites
Resources: HHSC Websites
  • CHIP Perinate:
    • http://www.hhsc.state.tx.us/chip/perinatal/index.htm
  • Billing Processes:
    • http://www.hhsc.state.tx.us/chip/perinatal/NewbornClaimsInstructions.pdf
  • Vital Statistics Instructions:
    • http://www.hhsc.state.tx.us/chip/perinatal/VitalStatisticsInstructions_062807.pdf
  • Hospital Training:
    • http://www.hhsc.state.tx.us/chip/perinatal/training.htm
  • TMHP general inquiries hotline and website:
    • 1-800-925-9126;
    • http://www.tmhp.com/Medicaid/default.aspx