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OB/GYN Billing Requirements

December 14, 2020

Dear Healthcare Professional Partner,

WellCare Health Plans of New Jersey strives to provide the best healthcare to its members and supports evidence-based models, such as Centering Pregnancy, to improve maternal and neonatal outcomes, and reduce health disparities related to race, ethnicity and socio-economic status.

Centering Pregnancy is an evidence-based healthcare delivery model, developed by the Centering Healthcare Institute (CHI) that integrates maternal healthcare assessments, education, and support.  Patients meet with a healthcare professional and other group participants for an extended period, at regularly scheduled visits over the course of their pregnancy. Centering Pregnancy promotes patient engagement and community building, and significantly improves infant health outcomes. Those outcomes, such as increased birth weight, increased gestational age, and increased satisfaction expressed by both the women and their healthcare professionals support the effectiveness of this model for the delivery of care. 

Billing Requirements:

  • CHI Certified Practice
  • Groups consist of no fewer than 2 and no more than 20 pregnant women
  • Completion of a health assessment at each group setting
  • Beneficiary participation of no more than 10 reimbursable group visits per pregnancy
  • 99078 TH Modifier and appropriate maternity diagnosis code

WellCare’s Provider Manual is at wellcare.com/New-Jersey/Providers/Medicaid.

Should you need to speak with someone, call WellCare Provider Services at 1-888-453-2534.

WellCare is committed to our members getting the care needed and supporting our providers as they take care of them. Please contact us should you have questions or concerns.

 

Sincerely,

 

WellCare Health Plans of New Jersey