Third Party Liability (TPL) Notification of Newborn Children Form

Third Party Liability (TPL) Notification of Newborn Children Form

ACT No. 269 – NEWBORN CHILD HEALTH INSURANCE COVERAGE

The Louisiana Health Insurance Premium Payment (LaHIPP) program provides group health insurance premium reimbursements to Medicaid recipients whenever it is formulaically determined to be less expensive than paying the total cost of health care services generally used by the recipient.

Information regarding the above rules may be obtained from the LaHIPP Program at (225) 342-1737 or 866-362-5253.

Third Party Liability (TPL) Notification of Newborn Children Form

Hospitals must complete the Third Party Liability (TPL) Notification of Newborn Children (TPLN 1-2005) Form which will begin the process of potentially providing health insurance premium reimbursements to a Medicaid eligible recipient. A copy of Form TPLN 1-2005 is provided for reference.

The TPLN 1-2005 Form is located at under Forms/Files/User Guides.

ACT No. 269 “Baby Bill” – Legislative Summary

  • Effective Date: 6/15/2005. The purpose of the Baby Bill is to establish reasonable requirements for the enrollment of newborns as dependents for health insurance coverage by health insurance issuers.
  • A newborn child that has access to dependent coverage under a mother, father or caregiver’s health insurance plan is considered enrolled as of the effective date of the birth of the child. This applies to individual and group policies.
  • If a newborn child has access to dependent coverage and is potentially eligible for Medicaid at the time of birth, then the hospital must notify DHH and the Health Insurance Issuer(s) (HIIs) by completing a Third Party Liability (TPL) Notification of Newborn Child(ren) form within seven (7) days. The notice should be sent to the Department of Health and Hospitals, Bureau of Health Services Financing, Third Party Liability/Medicaid Recovery. Notice to the Health Plans should be sent to a designated department that has been communicated to the provider or to the department that would normally be notified when a newborn child is added to a policy.
  • Upon receiving notice from the providers, HIIs must provide notice to the policyholder in the case of an individual policy, the employer and employee with regard to a group policy, and the healthcare facility that rendered any medical services provided to the newborn prior to discharge. The notice must include information
  1. verifying that coverage is available to the newborn child or if such coverage is not available, an explanation of why such coverage is not available;
  2. determining the amount of additional premium due, if any
  3. designating a contact including a telephone number and physical address to represent the HII to facilitate all matters relative to the newborn child.
  • HIIs must give DHH 90 day’s prior written notice of the intent to cancel the newborn child’s coverage due to non-payment of premium. Within 3 days of sending the letter to DHH, HII must notify each provider that has either submitted a claim, made the HII aware that it has treated, or requested/obtained a pre-certification to render services to the newborn child that the premium has been cancelled in which case the newborn would be covered under Medicaid. The notice must contain the following information:
  1. group or individual identification / policy number
  2. summary of benefits, including applicable co-pays and deductibles
  3. amount of additional premium due
  4. name(s) of the member subscriber of the newborn child, including, but not limited to, the names of any and all other dependents and the effective date of coverage for each person named as a dependent
  5. designated point of contact

A copy of ACT No 269 is provided for reference.

A copy of the Department of Health & Hospitals, Third Party Liability Newborn Notification Requirements proposed rule is provided for reference

LAC 37: Regulation 86 – Department of Insurance – Dependent Coverage of Newborn Childrenis provided for reference.