GIS 16 MA/013 - Processing Newborns in WMS

The purpose of this General Information System (GIS) message is to instruct upstate local departments of social services (LDSS) of the actions required to be taken when the Newborn Reporting System opens a Medicaid case for a newborn in WMS and the mother is active on NY State of Health.

The Newborn Reporting System is programmed to first process through WMS. When the mother is found to have Medicaid coverage in WMS, either currently or within the last three months, the reporting system will add the newborn to WMS even if the mother is currently active on NY State of Health. When the mother is not active on NY State of Health, no action is required to be taken on the WMS case. When the mother is active on NY State of Health but had coverage in at least one of the last three months in WMS, the newborn is opened on a child-only WMS case. To facilitate moving the newborn to the mother's active NY State of Health account, districts are required to take the following actions when reviewing the Daily Newborn Report. These actions must be taken daily prior to the nightly WMS batch.

Upstate WINR5225 Newborn Report

• Review the Upstate WINR5225 Daily Newborn Report and identify child-only cases by the infant's case number. WMS creates a new case number for the infant using the mother's CIN prefaced by "NE".
• Districts are instructed to delete the pending transaction prior to the nightly WMS batch if research in eMedNY shows the mother has active Medicaid on NY State of Health. The mother's NY State of Health account should be researched in eMedNY using the Client Identification Number (CIN), name or Social Security number. If the district cannot verify an active Medicaid case for the mother on NY State of Health, the district should not delete the pending WMS transaction which will open the infant's case on WMS.
• If the infant's case is not deleted prior to the nightly WMS batch, districts can still take action to close the case, if appropriate, prior to any claims being paid using Closing Reason Code E98, Newborn Case Opened in Error.
• Districts must notify their local district liaison of any newborn deletion/closing. Staff from the Department of Health's Office of Health Insurance Programs (DOH) will add the newborn to the mother's NY State of Health account.

Infants who are found on a child-only case at a later date in WMS

• When districts find a newborn that has been in WMS for less than three months on a child-only case and the case does not have any claims, including managed care capitation payments, the infant's case may be closed after verifying that the mother is active in NY State of Health using Closing Reason Code E98, Newborn Case Opened in Error. The district must notify its local district liaison of the closing. DOH staff will add the infant to the mother's NY State of Health account.
• For newborns that have been on WMS three or more months, or who were enrolled in managed care through WMS, or have a fee for service claim, the infant must remain in WMS and the case must not be closed.

Transition of the MAGI population to NY State of Health

• The transition of the MAGI population to NY State of Health, at renewal, presents an additional possibility for infants to remain in WMS on a child-only case. When a MAGI case is identified for transition, the case is closed in WMS but coverage remains active until the end of the authorization. Districts were previously advised in a May 3, 2016 M-Tag meeting and in the Medicaid Update session of the NYPWA Summer 2016 Conference that the Newborn Reporting System would convert the unborn on the mother's closed case. It should be noted that the Newborn Reporting System will not convert an unborn on a closed case. In these instances where a baby is born after a case has been identified and closed for transition, the Newborn Reporting System will open a child-only case for the infant with a new CIN. The infant will be authorized for 13 months of coverage.

For any child-only case that remains in WMS, workers must verify that the infant's coverage mirrors the mother's coverage for the month of birth and, if necessary, enroll the infant into the mother's health plan. At the time of the infant's renewal, the parents will receive a letter saying it's time to renew on NY State of Health. The infant can be added to the parents account on NY State of Health for continued coverage. The child should not be renewed in WMS.

Any questions regarding the information provided in this GIS message should be directed to your local district liaison.