|
Each MCO will designate a
"Newborn Coordinator" NC) who will serve as a point of contact for
providers who have questions or concerns related to the
eligibility of services to newborns within the first 60 days of
life. The Newborn Coordinator will be available through a
published, toll-free line, Monday through Friday, during normal
working hours 9:00 a.m. to 5:00 p.m. |
i
MCO
Newborn Coordinator
i
Provider Action
Grid |
Specifically, this Newborn Coordinator will be able to:
-
Research the
eligibility of a newborn whose MCO assignment is in question and
confirm for the provider the MCO to which the newborn belongs.
-
Interface with
Benova, the Maternal Child Health Hotline, the NC's that involve
multiple MCOs.
-
Facilitate and
confirm a PCP selection for a newborn whose PCP assignment is in
question.
-
Make retroactive
PCP enrollment and capitation adjustments where necessary.
-
In accordance
with MCO protocols, coordinate and authorize in-network care in the
case where the newborn does not yet appear in the MCO's system.
-
Coordinate and
authorize out of network care in the case where the MCO cannot offer
the newborn an appropriate in-network provider.
-
Coordinate with
the MCOs ancillary provider networks, such as pharmacy and durable
medical equipment, to facilitate the appropriate delivery of care for
a newborn whose eligibility may be of question and/or whose primary
care provider of record did not authorize or prescribe a service.
-
Request an ID
card for a newborn.
-
Provide general
guidance to providers and office staffs on newborn related issues.
-
Facilitate the
resolution of claims for services provided to newborns and/or direct a
provider to the appropriate claims contact for assistance
MCO Newborn Coordinators
Provider Action Grid
|
are PDF. Download
Adobe Acrobat Reader for viewing .pdf files
