MedicaidAdministrativeMedium impact
Procedure for Assuring Access to Care for Newborns of Women Enrolled in MCO on the Date of Birth
Maryland Medicaid·MD · Pediatrics, OB-GYN, Family Medicine·Managed Care Organizations
Effective date
Mar 29, 1999
We identified it
Jun 20, 2026
Summary
This Maryland Medicaid policy establishes procedures for ensuring newborns of HealthChoice (Medicaid MCO) enrolled mothers receive timely care and proper enrollment. It requires hospitals to complete DHMH 1184 forms immediately after birth, allows MCOs to reimburse out-of-network providers for initial newborn exams using CPT 99431 at minimum $25, and provides detailed steps for pediatric providers to verify enrollment and obtain authorization.
Action Required
Immediately: Maryland providers treating newborns of HealthChoice mothers must verify MCO enrollment through EVS system before providing care. Hospital staff must complete DHMH 1184 forms immediately after birth and fax to (410) 333-7012. Out-of-network providers performing initial newborn exams must bill MCO using CPT 99431. Pediatric providers must call MCO to request PCP assignment or obtain specific authorization before providing services to avoid claim denials.