News for Newborns! TennCare Newborn Presumptive Eligibility (NPE) - PowerPoint PPT Presentation

News for Newborns! TennCare Newborn Presumptive Eligibility (NPE) Presentation to the Tennessee Hospital Association August 20, 2014

New Options for Providers  Newborn presumptive eligibility  Streamlined birth reporting for CoverKids  New option for emergency TennCare 2

Newborn Presumptive Eligibility (NPE) 3

What is NPE?  Allows qualified entities to determine eligibility for newborns if mother not in TennCare.  Gives newborn NPE coverage while parents complete full TennCare application.  Effective August 18 th . 4

Distinguishing NPE  NPE is not “deeming” ◦ Deeming is for mothers already in TennCare at delivery. ◦ TennCare continues to deem.  NPE is different than PE for pregnant women. ◦ Local health departments continue to determine PE for pregnant women. 5

NPE Process  If mother not in TennCare, applicant completes one-page NPE form for newborn at qualified entity (QE) .  Applicant must sign and date NPE form.  Applicant does not need to submit any verifications. 6

NPE Process (cont’d)  QE employee determines NPE ◦ Compares income and HH size with TennCare limits (on back of form); and ◦ Explains determination to applicant and provides notice.  QE employee shall then sign and date NPE form. 7

NPE Process (cont’d) QE employee shall also:  If approving NPE, explain that applicant must complete a full TennCare application by the end next month.  Explain that the baby may lose eligibility if the applicant does not apply by the end of next month. 8

NPE Process (cont’d) QE employee shall also:  If denying NPE, explain that the applicant can also apply at www.healthcare.gov.  Whether approved or denied, the employee shall give the applicant a hard copy of the FFM application form. 9

When is NPE Period Effective? Coverage effective on Date of APPLICATION, not simply DOB. (Oh my.) 10

Avoiding Early Pitfalls  Make sure the NPE Form is complete. ◦ Newborn’s name ◦ Newborn’s DOB  Send us approvals only.  Tell us who you are and how to get in touch. 11

NPE Submission Process  Fax NPE forms during August.  Transition to submission of Daily Newborn Spreadsheet via SFTP2 by Labor Day.  Newborn’s eligibility will appear in TennCare Online Services within several days. 12

Transmitting until 9/1  Fax approved NPE Forms to 615-734- 5388 .  Fax birth certificates for “deemed” newborns to 1-855-315-0669 .  Don’t fax a Daily Newborn Spreadsheet. 13

To Review…. 14

New Options for Providers  Newborn presumptive eligibility  Streamlined birth reporting for CoverKids  New option for emergency TennCare 15

Making It Happen! 16

Next Steps for QEs  Legal Agreements  Technology  Training 17

QE Legal Agreements  TennCare must have a TPA and BAA with each QE.  Posted list noting which form required for each hospital (along with forms) .  Contact andrei.dumitrescu@tn.gov or call 615-507-6855 with questions. 18

QE Technology Needs  QEs will need SFTP2 server access to post “Daily Newborn Spreadsheet”.  Distributing SFTP2 server access instructions.  Contact don.oaks@tn.gov or call 615- 507-6334 with questions. 19

QE Front-Line Staff Training Visit www.tenncaretopics.com for :  NPE Form & Notice  Step-by-Step Guide  Continually-updated FAQs  Taped webinars  Daily Newborn Spreadsheet 20

Daily Newborn Spreadsheet 21

What Goes on DNS?  New presumptive and deemed babies  NOT data previously-reported  NOT CoverKids newborns 22

DNS Deadlines  You have five calendar days to report newborns.  Include only new data, not any previously-reported newborns.  Please report data ASAP (on same day if possible). 23

Funny Formatting  One row per newborn. ◦ Twins get two rows, triplets get three.  Only enter data in rows for which you are reporting a newborn. ◦ Otherwise, blank records generated.  No cut-and-paste. 24

Required Fields  We can’t require everything… ◦ Presumptive application date ◦ Baby’s SSN ◦ Mother’s SSN  But all other fields are ESSENTIAL. ◦ Otherwise, our system will reject your Daily Newborn Spreadsheet. ◦ Baby’s name is on the required list. 25

Double the Fun!  Why use double-entry method?  Enter, then re-enter.  Check for discrepancies – and correct. 26

Submission Protocol  Following naming convention.  File placement via SFTP2 access.  Post only one Spreadsheet per day.  Mistake? Call us!  Keep your copy! 27

Stump the Chump! (or email brian.haile@tn.gov) 28