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Newborn under mother denial

  1. Default Newborn under mother denial
    Medical Coding Books
    We are repeatedly getting denials stating that our newborn services must be billed under the mothers name... NOT just her ID# for initial newborn care at a birthing center. We've even humored the ins carrier by billing this way, only to have the claims denied as we had expected... age/sex/diag incompatible with CPT/ICD9 codes. The mother newborn act ensures that newborn care will not be denied for the first 48 hrs of vag del & 72 for csec however this is specific to INpatient billing. Birthing centers & homebirths are being denied inappropriately. Has anyone had any experience, or tricks they are willing to share?

  2. #2
    Tacoma, WA
    So do you put the mom's name, but then the baby's sex and birthdate? Can you add "newborn" next to the mom's name? Is it happening with all insurance carriers, or just certain ones?

    The problem generally happens because a computer is reading the claims and has specific denial edits built-in, so the trick is in bypassing those edits.

    Have you asked the insurance carriers how exactly they want you to include the info on the claims so that it gets processed correctly?

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