Back to Insights and Updates for ProvidersApril 2023

Submitting newborn claims appropriately

Tufts Health Together  |  Tufts Health Unify

As a reminder, MassHealth All Provider Bulletin 305 explains billing practices for newborn children of all MassHealth members and applies to Tufts Health Together and Unify plans. These guidelines require that providers bill for newborn services separately and not under the mother’s member ID number.

Inpatient hospital providers should use MassHealth’s Eligibility Verification System (EVS) to determine newborn eligibility status and submit claims to the appropriate payer with the newborn’s ID number. If providers are unable to find eligibility information for the newborn in the EVS system, claims for the newborn should be submitted directly to MassHealth.

It’s important to note that newborn claims billed under the mother’s ID number when the mother is covered by Tufts Health Together or Tufts Health Unify will be denied. For other plans, if the newborn has not yet been added to the plan, claims may be submitted under the mother’s ID number as outlined in the Newborn Payment Policy, which we’ve updated for further clarity.

Please keep in mind as well that MassHealth All Provider Bulletin 305 requires acute inpatient hospitals to submit an updated paper or electronic Notification of Birth (NOB-1 form and eNOB, respectively) to MassHealth within 10 days of the birth of a newborn of MassHealth enrollees. Upon receiving notification of a birth, MassHealth evaluates the information to determine the newborn’s eligibility for MassHealth coverage. For complete details, refer to MassHealth All Provider Bulletin 305.

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