Roles and Responsibilities

Each MCO will designate a "Newborn Coordinator" (NC) who will serve as a point of contact for providers who have questions or concerns related to the eligibility of services to newborns within the first 60 days of life.  The Newborn Coordinator will be available through a published, toll-free line, Monday through Friday, during normal working hours 9:00 a.m. to 5:00 p.m.

Specifically, this Newborn Coordinator will be able to:

• Research the eligibility of a newborn whose MCO assignment is in question and confirm for the provider the MCO to which the newborn belongs.

• Interface with Benova, the Maternal Child Health Hotline, the NC's that involve multiple MCOs.

• Facilitate and confirm a PCP selection for a newborn whose PCP assignment is in question.

• Make retroactive PCP enrollment and capitation adjustments where necessary.

• In accordance with MCO protocols, coordinate and authorize in-network care in the case where the newborn does not yet appear in the MCO's system.

• Coordinate and authorize out of network care in the case where the MCO cannot offer the newborn an appropriate in-network provider.

• Coordinate with the MCOs ancillary provider networks, such as pharmacy and durable medical equipment, to facilitate the appropriate delivery of care for a newborn whose eligibility  may be of question and/or whose primary care provider of record did not authorize  or prescribe a service.

• Request an ID card for a newborn.

• Provide general guidance to providers and office staffs on newborn related issues.

• Facilitate the resolution of claims for services provided to newborns and/or direct a provider to the appropriate claims contact for assistance.

MCO Newborn Coordinators' Phone Numbers

Provider Action Grid