BHSF Newborn Request Form – Fill Out and Use This PDF

The BHSF Newborn Request Form is a Louisiana Medicaid document that hospitals use to request a Medicaid ID number for newborns. Hospitals complete the form after delivery using the mother's Medicaid number, the baby's birth details, and hospital billing information. Submit this form as soon as possible to prevent delays in your newborn's healthcare coverage.

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BHSF Newborn Request Form PDF Details

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.

What Are the Three Parts of the Form?

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.

Why Does Accuracy Matter?

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

How to Edit Bhsf Newborn Request Form Online for Free

How to Fill Out the BHSF Newborn Request Form

Follow these steps to complete the form correctly and avoid processing delays:

Download the current version. Use the PDF available on FormsPal. Only the October 2006 revision is accepted by BHSF. Earlier versions are obsolete.
Complete Part I before delivery. Hospital staff fill in the mother's full name, Medicaid number, date of birth, and contact details.
Complete Part II after the baby is born. Enter the newborn's date of birth, sex, weight, and the name of the healthcare provider billing Medicaid. Note any special circumstances such as twin births or adoption.
Answer the discharge questions. The form asks where the baby will live after leaving the hospital and whether a Social Security number application has been filed.
Submit the completed form to BHSF. BHSF representatives complete Part III and confirm the newborn's Medicaid eligibility. Keep a copy for your records.

What Common Mistakes Should You Avoid?

The most common errors are missing fields and illegible handwriting. Always double-check the mother's Medicaid number. For twins or multiple births, a separate BHSF Newborn Request Form may be required for each child.

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