Claims Information

DHCS Encounter data reporting Mother and Newborn Coding Guidance

CCHP received the following Mother and Newborn coding guidance from the Department of Health Care Services. The document states, Childbirth encounter reporting includes inpatient and professional services provided to the mother and the newborn during admission. Newborns are covered under the mother's health plan ID for the first 30-days of life and are then assigned their own unique identifier. This means that hospitals will be reporting encounters for both the mother as well as the newborn(s) under the same health plan ID. In addition, providers of professional services, such as the obstetrician and pediatrician, will report encounters for their provision of childbirth services. Additionally, birthing services can also be provided by Alternative Birthing Centers (ABCs); which are included for reference as well.

View the full document here.

This document is intended to provide guidance to Managed Care health plans on coding and reporting standards as they relate to mother and newborn services provided during the course of childbirth which includes labor and delivery.

If you have any questions, please email the CCHP Claims Unit at ClaimStatus@cchealth.org.