Change Request Detail
Type of Request
Professional Claim (HCFA 1500)
DSMO Process Completed
Business Reason
Newborns which do not have insurance id number and must use mother's id number
In the insurance company information SBR segments or in the patient's PAT segment add a Y/N field indicating whether the id number is for a newborn or that the patient is a newborn so that these claims could be sent electronically.  We are experiencing a lot of denials for sex with sex specific procedures such as circumscision (54160, 54150, etc.) because the id number used is for the mother and also when billing 99460 (newborn care) we are receiving age denials from some companies.   We contacted the insurance companies involved with these denials and they told us we must send these type of claims on paper since according to them they do not have anyway of knowing is a newborn eventhough we specifically write the patient's name as NEWBORN and use the Claim note and Procedure Line Note and specifically write Insured's Newborn Baby. 
DSMO Category
Disapprove.  Suggest that requestor follow up with an HIR (  to layout the specific methodology for how to handle the validation of a newborn.
Appeal Recommendation