Baby Partners
Baby Partners provides support for your patients throughout pregnancy and postpartum. Our care coordination team is here to support your patient’s health care needs by helping them manage their care.
Baby Partners Services
- Ongoing telephonic care management by a nurse or social worker
- Home visits by a doula or nurse for high-risk members during pregnancy and postpartum
- Coordination of well mom and baby visits
- 24/7 breastfeeding helpline
- Transportation services to medical and behavioral health appointments
- Referrals to community resources for cribs, car seats and other help
- Prenatal and postpartum home care visits performed by an in-network home care agency. Prior authorization is not required for the following home care visits:*
- High-risk prenatal home care visits
- Postpartum well visits for mother and baby
- Nutritionist home care visits during the prenatal period
The removal of prior authorization for the above home care visits is effective for dates of service on or after June 1, 2016. Please be aware that claims for services for these codes will be denied outside of the specified timeframes detailed in the chart below. Please consult the chart below for suggested ICD-10 codes for correct claims submissions of postpartum home care visits.
|
Visit |
Focus of Visit |
Procedure Code |
Diagnosis Code |
| First visit between 1 to 21 days post-delivery, preferably within the first 7 days | Mother; use mother’s member ID | 99501 |
Z39.2, routine postpartum follow-up |
| Second visit before 84 days post-delivery | Mother; use mother’s member ID | 99501 |
Z39.2, routine postpartum follow-up |
| Visit for evaluation of baby only | Baby; use baby’s permanent or temporary member ID | 99502 |
Z00.111 if baby is under 28 days old; Z00.129 if baby is over 28 days old and normal findings; Z00.121 if baby is over 28 days old and abnormal findings. |
Note: Prior authorization is required for all medically necessary home care services. To request services, please fax a completed Home Care Authorization form to 215-967-4491.
*One well-baby visit is covered without prior authorization. If further visits are medically indicated, follow the usual procedure code for obtaining prior authorization.
Maternity Home Visiting Program
The Maternity Home Visiting program provides at least two home visits to recently delivered members. The focus of the visits is child development, parenting and referral to any needed community resources. Providers can refer members by emailing Libby Cohen at ecohen@hpplans.com; members can also self refer.
Any parent may request a home visit. Members with the following diagnoses or situations will be referred to the program by HPP’s care coordinators: all first-time parents; parents with substance use, tobacco use, or behavioral health diagnoses; and involvement with child protective services. If ongoing support is needed, the family will be connected with an appropriate provider for continued support. Note: Because of the COVID-10 public health emergency, visits are conducted by phone or video call.
ONAF Reimbursement Program
Measurement Year 2023
HPP has implemented a new reimbursement program for the submission of Obstetrical Needs Assessment Forms (ONAF). The incentive is available to all OB providers in HPP’s network and went into effect on January 1, 2023.
Effective for the 2023 calendar year, the ONAF measure will be removed from the Maternity Quality Care Plus (MQCP) program. In the new ONAF program, providers will be eligible for a maximum of $200 total incentive for submission of one complete prenatal and one complete postpartum ONAF form. All ONAFs must be submitted and accepted electronically via Optum. Providers will receive payments quarterly.
|
Form |
Reimbursement |
|
Prenatal/Initial ONAF* |
$125.00 |
|
Postpartum/Final ONAF |
$75.00 |
* Must be submitted within 7 days of initial prenatal visit.
HPP relies on your prompt submission of the Obstetrical Needs Assessment Form (ONAF) to enroll Medicaid members into our Baby Partners program and collect important clinical and quality data. Please note that rejected ONAFs will not be paid unless corrected and re-submitted within the appropriate timeframe. We are excited about this new incentive and will work with you to help implement it for your practice.
Measurement Year 2022
For measurement year 2022, the ONAF was included as a quality measure in the Maternity Quality Care Plus incentive program for OB providers. Results for MY 2022 are recalculated in April 2023 and a new payment cycle, that includes incentive payments based on the percentage of your eligible members for which a completed ONAF was submitted, begins in May 2023 through April 2024. Incentive payments are based on how well your practice meets predefined benchmarks. Providers that meet one of two benchmark tiers, Good Performers (Tier 1) and Highest Achievers (Tier 2), will earn incentives for the ONAF measure as part of their MQCP payments. Moving forward, the measure has been removed from MQCP.
If you have additional questions, please reach out to your Provider Relations Representative or contact our Provider Services Helpline at 1-888-991-9023, Monday – Friday, 9 a.m. – 5:30 p.m.