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Newborn billing under mother or child?

  1. Default Newborn billing under mother or child?
    Medical Coding Books
    Our physician does not see newborns in the hospital we strictly see newborns from 2 weeks and on.

    We always bill the newborn under their own name, DOB and under the mothers insurance plan for the first 30 days (as long as she added them).

    One mother states she added the child from birth but the insurance company shows the child was added two weeks after the DOB. They are not showing the child effective the first two weeks of life. The mother has called numerous times to have them change to the childs DOB as she originally registered but instead of adding the childs name to the plan from the DOB they want us to bill under the mothers name for the childs charges the first two weeks. Is this normal? I have seen this before but only if the child does not have a name.

    Any insight on this would be awesome! If this is the norm would you bill under the mother w/ her DOB or the Childs as it seems they would deny due to pediatric codes on an adult.

  2. Default
    Many policies pay the newborn's claims when they come in under the mother for the first 30 days. I used to have problems with circumcisions billed under a woman! Anyway, I would document who told you to do it and the time and date of the call and then I would do it. I do not think it is that big of a deal, IMO.

  3. #3
    I used to work for a payer & dealt specifically with newborn cases. We recommended to the provider to bill all the newborn charges under the Mother's policy for the 1st 30 days. At the same time explaining that if the newborn isn't added within the required time, payment recoupments could take place later.

    The payer I worked for would pay them under the Mother. Once the newborn was added I was responsible for moving those claims to the newborn's account without the provider having to resubmit them. This is likely not the practice for all payers. I would be calling the payer to verify.

    The plan effective date for the newborn is likely an enrollment error on the subscriber/mother's part or the actual payer's enrollment department's part.
    Again, I would be calling that payer to find out more. Don't depend on just what the Mother is telling you. I would ask them about the enrollment date vs. newborn DOB discrepancy. Document, make notes in the account & get things in writing! Your provider's payment depends on it :-)

    Good luck!

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