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Bright Beginnings Prenatal Incentive Program

Audience: Physicians and Nurse Midwives

As you may know, we provide an incentive to participating physicians and nurse midwives providing prenatal care to members enrolled in “Safety Net” (Child Health Plus, HMOBlue Option, Blue Choice Option, Premier Option, and Premier Child Health Plus) products through our Bright Beginnings program.

  • Excellus BlueCross BlueShield would like to remind you to use the Prenatal Incentive Registration Form when submitting your claim. You can find the form under Administration in View Forms and Documents. If you do not have Internet access, contact Customer Care at 1-800-920-8889 to obtain a copy of the form.

The address on the submission form has changed.  The claim should be attached to the completed Prenatal Incentive Registration Form and faxed to the number on the form and mailed to:
Claims Department
P.O. Box 21146
Egan, MN 55121-0146

How the Prenatal Incentive Program Works

  • The program is encouraged by the New York State Department of Health as a means for OB/GYNs, nurse midwives, and family practice physicians to notify health plans of pregnancies within the Medicaid population. The goal is to improve prenatal care outcomes.
  • Incentive payment is awarded when:
    • The provider determines pregnancy risks during the initial care and office visit and completes our Prenatal Incentive Form, which is a health risk assessment that enables our Bright Beginnings Case Management team to evaluate the patient’s health care needs and coordinate her care.
    • Following the visit, the provider must:
      1. Fax the completed Prenatal Incentive Form to our Bright Beginnings Case Management department at 1-866-838-7617, AND
      2. Mail the claim for the office visit with a copy of the completed Prenatal Incentive Form that was faxed to our Bright Beginnings Case Management department.
    • The claim should contain the following:
      • Coding: CPT code 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form.) Use CPT code 99080 along with the following applicable ICD codes.
        ICD-9 ICD-10
        V22.0 Z34.01
        Z34.02
        Z34.03
        V22.1 Z34.81
        Z34.82
        Z34.83
        Z34.91
        Z34.92
        Z34.93
        V23.9 O09.91
        O09.92
        O09.93
      • Billing: The claim will be processed to pay the billed amount based on the trimester of pregnancy:
        • First trimester: bill $50
        • Second trimester: bill $30
        • Third trimester: bill $20

Note:

  • The incentive will only be awarded when care is delivered during the member’s pregnancy. Payment is awarded one time (meaning the form cannot be submitted multiple times during the member’s pregnancy). No payment will be awarded following delivery. No other services should be included on the claim. For more details about our programs, please see our Safety Net Case Management Program brochure.
  • No financial incentive is provided to the member.

If you have questions or would like additional information about this program, please contact your Provider Relations representative. Thank you for the quality of care and service that you provide to our valued members

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Excellus

Utilization Management