Sec. 10.67.04.27. Newborn Coordinator

A. An MCO shall identify a newborn coordinator who shall be available to providers during the MCO's business hours as a contact for concerns related to eligibility and provision of services to newborns.

B. The newborn coordinator shall provide services for a newborn:

(1) Whose mother is enrolled in the MCO on the date of the newborn's birth; and

(2) Who is enrolled or who is autoassigned to the MCO after birth.

C. The newborn coordinator shall:

(1) Research and confirm the assignment of an eligible newborn to a managed care organization;

(2) Interface with the enrollment agent, the Department, the newborn coordinators of other MCOs, and the provider to resolve any eligibility issues involving multiple MCOs;

(3) Facilitate and confirm the selection of a primary care provider for an eligible newborn;

(4) Request an MCO ID card for a newborn when necessary;

(5) Make retroactive PCP enrollments when necessary;

(6) Facilitate the resolution of claims for services provided to an eligible newborn;

(7) Provide general guidance to providers and their office staff on newborn-related issues;

(8) Coordinate with ancillary care providers to facilitate appropriate delivery of care and payment of claims; and

(9) Coordinate and authorize in-network care when the newborn does not yet appear in EVS or the MCO's system, or out-of-network care when the MCO cannot offer an appropriate in-network provider.