CHIP Perinatal-Labor with Delivery Changes

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CHIP Perinatal-Labor with Delivery Changes

• Form H3038

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Objective

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

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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.

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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.

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Health Plan Billing

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

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Front
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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.

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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.

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Front
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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 Emergency
  Medicaid 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.

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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.

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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.
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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

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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

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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)

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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.

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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 mothers CHIP
  perinatal ID number must be written on the top of
  the form.

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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.

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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

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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 plans website.
• Contact health plan by calling plans provider
  hotline

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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.

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Resources HHSC Websites

• CHIP Perinate
• http//www.hhsc.state.tx.us/chip/perinatal/index.h
  tm
• Billing Processes
• http//www.hhsc.state.tx.us/chip/perinatal/Newborn
  ClaimsInstructions.pdf
• Vital Statistics Instructions
• http//www.hhsc.state.tx.us/chip/perinatal/VitalSt
  atisticsInstructions_062807.pdf
• Hospital Training
• http//www.hhsc.state.tx.us/chip/perinatal/trainin
  g.htm
• TMHP general inquiries hotline and website
• 1-800-925-9126
• http//www.tmhp.com/Medicaid/default.aspx