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Presumptive Eligibility for Pregnant Women and New Notification of Pregnancy Form

Presumptive Eligibility Update

Click here for key facts about Presumptive Eligibility.

Click here for more detailed information regarding Presumptive Eligibility.

Click here to find a Presumptive Eligibility Qualified Provider.

What You’ll Want to Know — 3 important facts about Presumptive Eligibility:

  1. Presumptive eligibility (PE) allows a pregnant woman to receive ambulatory prenatal services while her Hoosier Healthwise application is being processed.
  2. No documentation is required from the pregnant woman for the Qualified Provider to make the determination that a woman is presumptively eligible.
  3. Providers that bill for services while a woman is on PE will not have reimbursement taken back if the woman is later found ineligible for Medicaid.

New Notification of Pregnancy Form

Effective July 1, the Office of Medicaid Policy and Planning is launching a new Notification of Pregnancy form for use with pregnant Medicaid recipients.

Click here for key facts about the Notification of Pregnancy form.

Click here for more detailed information regarding the Notification of Pregnancy form.

What You’ll Want to Know — 3 important facts about the new Notification of Pregnancy form:

  1. The Notification of Pregnancy (NOP) form is a comprehensive risk assessment used by all three Medicaid managed care organizations. NOPs have been associated with improving birth outcomes for women enrolled in Medicaid.
  2. Prenatal care providers that complete and electronically submit the NOP using Web interChange may receive $60 for each form submitted within 5 days of seeing the patient.
  3. The NOP risk assessment includes questions about maternal and obstetrical history, mental health, substance abuse, and social risk factors. The Medicaid MCOs will use this information to identify and address risk factors, and ultimately, to improve birth outcomes.

For more information, contact Caitlin Priest MPH, Director of Special Projects and Public Policy at (317) 924-0825 ext. 4231 or cpriest@indianaperinatal.org.