Maternity Claims: Adjusted Procedures (For EmblemHealth, GHI and HIP Benefit Plans)

Date Issued: 9/11/2009

(For EmblemHealth, GHI and HIP Benefit Plans)

Beginning September 11, 2009, Group Health Incorporated (GHI), an EmblemHealth company, will adjust the payment method for the submission of claims for maternity-related services for GHI and EmblemHealth EPO and PPO members. By following this new procedure, your claims will be processed faster and should make your office's administrative tasks easier. (We also recommend that practitioners submit claims for maternity-related services in the same manner for every benefit plan, including HIP and EmblemHealth CompreHealth.)

Please submit your claims using the following method:

  • Submit claims for maternity-related service(s) in three installments, utilizing CPT Industry Standard Coding Guidelines; the first claim for antepartum care, the second for delivery care, and the third (final) for postpartum care.

You may continue to submit a single claim for antepartum care, delivery care, and postpartum care, but the preference is for submission of claims in three installments.

More Important Information for GHI and EmblemHealth EPO and PPO
Sometimes your patient does not carry the pregnancy to full term or may transfer to another practice for obstetrical care. If this is the case after September 11, 2009, we will send you a form to confirm the reason obstetrical care was discontinued after your claim is submitted. Check the appropriate lines on the form and return it to us.

If you have questions, or require assistance with these changes, please contact our Provider Customer Care Advocates at 1-866-447-9717.