TP 45

Customer Care Center (CCC) Data Integrity (DI) uses the Provider Referral Process when a hospital, birthing center or Federally Qualified Health Center (FQHC) submits a referral directly to DI for a newborn whose mother is Medicaid eligible. The provider does not submit a claim for payment to the claims administrator for the child at this time.

DI verifies the mother's Medicaid coverage, which can be retroactive, and creates a TP 45 EDG for the newborn.

Coverage for the child begins on the child's date of birth (DOB). The last month of coverage is the last day of the month that the child turns one, except in the following situations:

The hospital notifies DI through the Texas Electronic Registration (TER) system or Form 7484, Hospital Report for Newborn Child or Children , that the child's mother relinquished her parental rights. If TER or Form 7484 indicates a relinquishment, but the new caretaker’s information is incomplete or not provided, DI provides newborn Medicaid coverage from the child's DOB through the end of the month the child is relinquished. If TER or Form 7484 indicates a relinquishment, and the new caretaker’s name and address are provided, DI completes two case actions. The first action is to process an open and close newborn Medicaid EDG with the birth mother as the case name. The coverage begins with the child’s DOB and continues through the end of the month the child was relinquished. The second action is to open a newborn Medicaid case or EDG with the new caretaker as the case name. The coverage begins the first of the month after the original newborn Medicaid coverage ended and continues through the month of the child’s first birthday.

The child's mother received TP 42 Pregnant Women Presumptive coverage at the time of the child's birth, and the mother's application for regular Medicaid coverage is denied. DI certifies the child through the birth month.

The computer generates and sends the following documents for each EDG:

Notice of the newborn's individual number to the referring provider and other providers, if identified on the provider's referral;

Your Texas Benefits Medicaid card to the newborn's mother; and

Notice informing the newborn's mother or caretaker: that the child is eligible to receive medical coverage through the month of their first birthday while they remain a Texas resident and to report any changes concerning these eligibility requirements; to report any incorrect information on Form H1027-A, Medicaid Eligibility Verification ; to report if the newborn's siblings receive TANF; and if the mother's Medicaid end date changes because the child was not born in the anticipated month.