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Las cartas sobre el reembolso del MLR se enviaron por correo el 30 de septiembre. Revise su correo antes del 15 de octubre para obtener más información. Obtenga más información.

Las cartas sobre el reembolso del MLR se enviaron por correo el 30 de septiembre. Revise su correo antes del 15 de octubre para obtener más información. Obtenga más información.

News

Newborn Inpatient Stays Policy: Effective May 1, 2026

Fecha: 25/02/26

Thank you for your continued partnership with Ambetter Health. As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of a new policy that Ambetter Health will be implementing effective on or after 5/1/2026.

Policy Number

CC.PP.075

Policy Name

Newborn Inpatient Stays 

Line of Business Impacted

Medicaid, Marketplace

EX Code

Medicaid: EXfz (Retain Pay): Healthy Newborn Claim paid per policy, remit records for reconsideration.

Marketplace: EXhn (Retain Pay): Healthy Newborn Claim paid per policy, remit records for reconsideration 

Description

Review claims for coding appropriateness when normal newborn stays with non-NICU revenue codes are billed.

Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.