Provider Alert! Neonatal Level of Care Designation Updates
Date: August 28, 2018
Attention: All Hospitals
Subject: Neonatal Level of Care Designation Updates
Effective for dates of service on or after September 1, 2018, hospitals enrolled in Texas Medicaid may be reimbursed for inpatient neonatal services only if the hospitals have received a neonatal level of care designation from the Department of State Health Services (DSHS) in accordance with 25 Texas Administrative Code §§133.181-133.190.
Requirements:
Hospitals with neonatal units must have a level of care designation. Information on these requirements and an application can be found at www.dshs.texas.gov/emstraumasystems/formsresources.shtm#neonatal.
Neonatal claims are defined as facility claims with revenue codes 171-174 and the age of the member at the time of admission is 0-28 days.
TCHP will validate the neonatal claim to the DSHS designation. If the facility does not have a level of care designation, the claim will be denied.
- Address – The address provided on the claim must match exactly to the address submitted on the application to DSHS.
- Site – For hospital systems, all site locations must have an approved level of care designation from DSHS.
For additional rules and requirements, please refer to TMHP information on neonatal levels of care or visit the DSHS website at http://www.dshs.texas.gov/emstraumasystems/neonatal.aspx.
If you have any questions, please email Provider Network Management at providerrelations@texaschildrens.org.
Provider Relations
Texas Children’s Health Plan
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