MedicaidAdministrativeHigh impact
Wisconsin Medicaid will no longer reimburse claims submitted for newborns under the mother's identification number
Wisconsin Medicaid (ForwardHealth)·WI · OB-GYN, Pediatrics, Family Medicine·Billing
Effective date
Oct 1, 2003
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid will no longer allow claims for newborns 10 days old or younger to be submitted using the mother's Medicaid ID number. Providers must obtain and use the newborn's individual Medicaid identification number for all claims, with implementation tied to HIPAA requirements in October 2003.
Action Required
By October 2003: Billing team must stop using mother's Medicaid ID numbers for newborn claims (10 days old or less). Update billing system to require newborn's individual ID number obtained through Wisconsin Medicaid's Eligibility Verification System (EVS). Remove local diagnosis code 'M11' from CMS 1500 claims and occurrence codes '50' and '51' from UB-92 claims for mother/baby billing. Ensure proper Newborn Report forms (HCF 1165) are submitted to obtain newborn ID numbers. Claims submitted with mother's ID will be denied after the effective date.