Newborn Enrollment
Upon a SHP’s member delivery of a baby, the newborn is not automatically enrolled with the Plan. SHP will create a temporary newborn record within the system and work with the Department of Children and Families (DCF) to have an activation form completed. Once this is done, the newborn will become eligible/active with SHP.
* PCP’s are required to notify SHP within two (2) working days of the first prenatal visit and/or positive pregnancy test by completing the Pregnancy Notification Form (Refer to the Forms section at the end of the Handbook). Once this form is received, SHP will notify the designated DCF Customer Support of a member’s pregnancy.
* Hospitals are required to notify SHP when a pregnant member presents to the hospital for delivery. This notification is to be done as per the approved Plan process. Once notified, SHP will research if the newborn has an existing record on FMMIS that is waiting activation. Upon notification of a delivery, SHP will notify the Florida State Medicaid of the delivery.
* SHP will be responsible for payment of covered services for each enrolled newborn for up to the first (1st) three (3) months of life, provided the newborn was enrolled through the Unborn Activation Process. If it is determined that SHP was not notified of a member’s pregnancy and the first step of the Unborn Activation Process was not completed before the member presented to the hospital for delivery, the newborn will not be a member of SHP upon birth. As a result, SHP will not be responsible for payment of any services rendered to the newborn until such time that the newborn becomes a member of the Plan. If the Unborn Activation Process was not followed, SHP will not be responsible of covered services provided by the hospital, the pregnant member’s attending physician and the newborn’s attending or consulting physician. Providers will be required to file claims for services provided to the newborn through the Medicaid Fee-for-Service process.
