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.
Participants will be able to describe the new process used to cover the labor and delivery costs for eligible CHIP perinatal mothers.
The health plan identification card shows billing to the health plan for both Professional/Other Services Billing and Hospital Facility 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.
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.
New Process Continued
CHIP Administrator mails mothers who are eligible for CHIP perinatal coverage with income at or below 185% of the FPIL a:
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.
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:
The physician who delivers the baby typically completes the Emergency Medical Services Certification Form H3038, at the time of delivery.
Hospital staff can return the completed form by:
PO Box 14400
Midland, TX 78711-4400)
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.
One month following the expected due date, if HHSC has not received a Emergency Medical Services Certification Form H3038, the mother will receive:
Verifying PCN/Medicaid number for mom and baby (185% FPL and below):
Options for verifying CHIP perinatal eligibility:
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.