Ga. Medicaid Part II Policies & Procedures for Hospital Services, Appendix E

A. Summary Of Newborn Eligibility

The Department implemented a new process to expedite the enrollment of Medicaid eligible

newborns. This process enables authorized providers to immediately obtain a Medicaid

identification number for a newborn infant, born to a mother eligible for Georgia Medicaid

benefits.

Any Physician, Nurse Midwife, Nurse Practitioner, Health Check Provider, Pharmacy, Hospital,

Health Department, Durable Medical Equipment Provider, or Birthing Center enrolled as a

Georgia Medicaid Provider can obtain a Medicaid identification number for these newborn

infants. Enrolled providers can access Gainwell Technology on-line to obtain a Medicaid

identification number. Additionally, the manual process, requiring completion of the Newborn

Medicaid Certification form, DMA-550, remains in place for enrolled providers who are unable

to execute the on-line process. Procedures for both the on-line and manual processes for obtaining

a Medicaid identification number for a newborn are specified in this section.

B. Manual Procedures for Obtaining Newborn Identification

The manual process requires completion of the form DMA-550, Newborn Medicaid Certification.

Upon completion of the form and obtaining the parent’s/relative’s signature, adhere to the

following:

i. Contact Gainwell Technology at 1-800-766-4456 to obtain a Medicaid identification

number. Enter that number on the form.

ii. The blue or Certifying Provider copy is retained in the certifying provider’s records.

iii. Give the parent the pink (Client) and yellow (Pharmacy) copies of the form. These are

temporary Medicaid certificates. They serve as proof of Medicaid eligibility, and they

should be presented to the infant’s medical care and pharmacy providers.

1. In order to confirm issuance of the number and Medicaid eligibility, mail the

white copy of the form to:

Gainwell Technology

P.O. Box 105200

Tucker, Georgia 30085-5200

NOTE:

The month after the number is issued; the infant will receive the plastic Medicaid member

identification card.

iv. CAUTION: Providers are encouraged to exercise care when executing the on-line

process. Errors on a Presumptive Eligibility record will cause denials or delays in the

payment of claims.

v. After the system accepts the information and issues a member identification number,

errors on a record, such as an incorrect date of birth, the wrong gender, or an improper

spelling of a name cannot be corrected through the system. This must be corrected by

contacting the PROVIDER UNIT AT 1- 800-766-4456. When contacting the Provider

Unit, describe the erroneous information and state the correct information on the

Presumptive Eligibility Pregnancy Medicaid Corrections Report. COMPLETION OF

THE NEWBORN MEDICAID CERTIFICATION

vi. This section includes instructions for completing the Newborn Medicaid Certification

(DMA-550). This form should only be used for infants who have not yet received their

Georgia Medicaid member ID card. After this form has been completed, contact the

Newborn Enrollment unit at 1-800-766-4456 to receive the infant’s member ID number.

This number should be entered in the upper right-hand corner of the DMA-550.

Sample of DMA-550: Newborn Medicaid Certification form next page:

Newborn Medicaid I.D. No.

Certifying provider must contact the Newborn Enrollment unit to obtain the newborn I.D.

number.

From (DOB)

Enter the newborn’s date of birth in MM/DD/YY format.

Thru

The Newborn Enrollment unit will provide this date.

Newborn’s Name

Enter the complete name. The first name should be entered first, followed by the middle

initial, last name and suffix.

Date of Birth

Enter the newborn’s date of birth in MM/DD/YY format.

Sex

Check the appropriate box for the sex of the newborn.

Mother’s Name

Enter the mother’s complete name. The first name should be first, followed by the middle

initial and last name.

Mother’s Medicaid I.D. No.

Enter the mother’s Medicaid identification number exactly as it appears on the mother’s

Medicaid member identification card.

Mother’s Social Security Number

if available, enter the mother’s Social Security number.

U.S. Citizen

Check the appropriate box indicating the citizenship status of the mother.

Mailing Address

Enter the mailing address of the newborn. Also enter the name of the county of residence

and telephone number of the mother including the area code.

Date of Request

Enter today’s date.

Parent/Relative Signature

The parent or guardian must sign the certification. An unsigned certification will not be

accepted for processing.

Completed by (Please Print)

Enter the name of the person completing this certification.

Title

Enter the title of the person who is completing the certification.

Provider Name

Enter the provider’s name.

Telephone No.

Enter the provider’s telephone number including the area code.

Provider Signature

The provider must sign or signature-stamp each certification. Unsigned certifications will

not be accepted for processing.

Date Completed

Enter the date the provider signed the certification.

Provider Number

Enter the provider’s Medicaid number.