The BHSF Newborn Request Form is issued by the Louisiana Department of Health and Hospitals Medicaid Program. Its purpose is to assign a Medicaid ID number to newborns so hospitals can bill for care provided after birth.
The form has three distinct parts. Part I is completed by hospital staff before delivery. It requires the mother's full name, Medicaid number, and date of birth. Part II is completed after the baby is born. It records the newborn's sex, birth date, and the healthcare providers who will bill Medicaid. Part II also covers special situations such as multiple births, adoption, or the death of the newborn. Part III is completed by BHSF staff after review. It confirms the newborn's eligibility for Medicaid coverage.
Incomplete or illegible entries delay Medicaid ID assignment. A missing or incorrect mother's Medicaid number will stop processing. The form was revised in October 2006. Earlier versions are obsolete and will not be accepted. Always use the current version of the BHSF Newborn Request Form available on FormsPal.
| Question | Answer |
|---|---|
| Form Name | BHSF Newborn Request Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | 152n102006 Newborn Request Form, Louisiana Medicaid Newborn Form |