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Refresher TrainingCHIP 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, andAll 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

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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.

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, andSelf-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 orRegular 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, orMailing 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 receipt1-866-291-1258 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.comCall 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:melissa.rodriguez.3@hhsc.state.tx.us1-512-977-6202 or 1-866-291-1260

Inquiry lists must include the following information: CHIP perinatal case numberMom's nameDates of ServiceDate 3038 was faxed to MAXIMUS

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Inquiry Results

Form H3038 locatedCPC provides Medicaid ID numberProvider can bill:

• Facility charges to TMHP• Professional charges to CHIP perinatal Health Plan

Form 3038 not locatedHospital asks patient to apply for Emergency

Medicaid at local HHSC officeForm H3038 must be completed and returned before

Emergency Medicaid can be certifiedPatient 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/NewbornClaimsInstruc

tions.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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