Transcript Refresher Training CHIP Perinatal

Refresher Training
CHIP Perinatal-Labor with
Delivery Changes
Emergency Medical Services
Certification - Form H3038
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Objectives
Hospital provider staff:
Can describe the process used to cover the labor
with delivery costs through Emergency Medicaid
for eligible CHIP perinatal mothers.
Follow established procedures to check status of
H3038.
Know processing timeframes from submission of
H3038 to payment date.
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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 For Delivery
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 for this
income group.
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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.
Front
Back
5
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.
Front
Back
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Stream Lined Emergency Medicaid
CHIP perinatal clients with income at or below
185% of the FPIL are not 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
Mothers who are eligible for CHIP perinatal
coverage with income at or below 185% of the
FPIL receive:
 Enrollment Confirmation Notice,
 Bar coded Emergency Medical Services Certification
Form H3038, and
 Self-addressed postage paid envelope.
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Bar Coded Image
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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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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Cover Sheet Requirements
Mother’s name as it appears on the CHIP
perinate card
CHIP perinate case number
Baby’s name
Baby’s date of birth
Baby’s gender
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Submitting the Form
Hospital staff can return the completed form by:
 Faxing to 1-877-542-5951, or
 Mailing to: HHSC
PO Box 14400
Midland, TX 78711-4400
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Processing of 3038
Once the form is faxed, state eligibility workers
have up to 45 days to process it.
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Verify Receipt of Form H3038
The patient can verify receipt of the Form H3038
by calling:
 1-800-647-6558 to verify receipt
 1-866-291-1258 to verify the processing status.
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Verification of Coverage
Providers can verify PCN/Medicaid number for
mom and baby (185% FPL and below):
 On TMHP web portal: www.tmhp.com
 Call TMHP help line for assistance
• 1-800-925-9126
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Verifying Coverage
Prior to submitting an inquiry request, providers
with accounts 40 days old or older should
contact:
Angela McKnight
1-512-533-2954
or
Denise Townsley
1-512-533-3581
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Inquiry Request
Providers email or fax inquiry requests to
Melissa Rodriguez’ attention at:
 [email protected]
 1-512-977-6202 or
 1-866-291-1260
Inquiry lists must include the following
information:
 CHIP perinatal case number
 Mom's name
 Dates of Service
 Date 3038 was faxed to MAXIMUS
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Inquiry Results
Form H3038 located
 CPC provides Medicaid ID number
 Provider can bill:
• Facility charges to TMHP
• Professional charges to CHIP perinatal Health Plan
Form 3038 not located
 Hospital asks patient to apply for Emergency
Medicaid at local HHSC office
 Form H3038 must be completed and returned before
Emergency Medicaid can be certified
 Patient can be billed if patient does not follow through
with application process
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Failure to Return Form H3038
A new application for assistance is required if
Form H3038 is not submitted within 30 days of
delivery. Eligibility for Emergency Medicaid
must be determined based on current
household information.
Eligibility for the new application is determined
by either hospital based staff or staff at a local
HHSC office.
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Resources: HHSC Websites
CHIP perinatal:
 http://www.hhsc.state.tx.us/chip/perinatal/index.htm
Billing Processes:
 http://www.hhsc.state.tx.us/chip/perinatal/NewbornClaimsInstruct
ions.pdf
Vital Statistics Instructions:
 http://www.hhsc.state.tx.us/chip/perinatal/VitalStatisticsInstructio
ns_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
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Thanks for joining us!!!
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