Deemed Baby Claims 712 Edit Code



On Jan. 26, 2015, the South Carolina Department of Health and Human Services (SCDHHS) released a provider alert, Deemed Baby Process and Assumptive Eligibility for Pregnant Women, a reminder that certain well-child services to newborns (deemed babies) may be billed under the mother's Healthy Connections Medicaid identification (ID) number when the mother is enrolled on fee-for-service and not in a Managed Care Organization (MCO). This reminder was issued in an effort to encourage providers to continue providing medically-necessary services to newborns and assist in reducing financial burdens providers may have experienced as SCDHHS transitions to a new eligibility system.

Since the release of this alert, it has been brought to SCDHHS's attention that claims for the following procedures were missing from the Physicians, Labs and Other Medical Professionals Manual and claims for these services were denying inappropriately with the 712 edit code:

  • 99381- E/M initial comprehensive preventative medicine (age younger than one years old)
  • 99391- E/M periodic comprehensive preventative medicine (age younger than one years old)

The agency has identified 370 previous billed claims (since November 2014) where CPT codes 99381 or 99391 were billed under a mother's Healthy Connections Medicaid ID number and rejected due to the 712 edit code. These claims will be recycled through the claims processing system to alleviate any additional burden on the provider community. Providers will see these payments in their remit for March 20, 2015. The provider manual will also be corrected to include CPT 99381 and 99391 as billable services under the mothers Medicaid ID.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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