CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Payment Policy Home Births

Governs BCBSRI coverage and payment rules for home births, including credentialing of participating providers, covered services, member liabilities, billing rules, and transfers to facility; affects participating providers and members covered by Blue Cross Blue Shield of Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyPayment Policy Home Births

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateDec 6, 2011

Next Review DateN/A

Key ActionParticipating providers must notify BCBSRI, be credentialed specifically for home births, and carry liability insurance that includes coverage for home births.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

oneE/M service covered in home if transfer and another clinician delivers

up to 3 hoursadditional prolonged services covered with direct care if provided during transfer

credentialing requiredParticipating providers must be credentialed specifically for home births

liability insurance requiredProviders must carry liability insurance that includes coverage for home births

global maternity rules apply

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Home Birth Coverage and Billing Rules

Home birth coverage criteria

Covered when the following conditions and billing rules are met:

Home birth services are covered, including routine antenatal, delivery, and postpartum care

Member liability (NOT covered)

Additional prenatal counseling sessions or prenatal evaluation/management services specifically related to home birth
Equipment and supplies including emergency items and any home birth kits
Charges related to prolonged personal attendance
Home modifications
Standby services such as supplies, equipment, support personnel, or ambulance

Provider requirements

Participating providers must notify BCBSRI and be credentialed specifically for home births
Participating providers must carry liability insurance that includes coverage for home births

Billing and global maternity rules

All global maternity policies apply
A provider may not bill prenatal care when another provider is billing prenatal services for the same period
No additional prenatal Evaluation and Management services related to high-risk pregnancies for home birth patients will be covered

Transfer to facility

If a patient is transferred during labor and another clinician performs the delivery, BCBSRI will cover up to one E/M service in the home
BCBSRI will cover up to 3 additional hours of prolonged services with direct care if provided during transfer

Coding and Billing Guidance

Coding guidancemixed

Coding: Not applicable

Prenatal E/M for high-risk (inv-03)

Policy statementNo additional prenatal Evaluation and Management (E/M) services related to high‑risk pregnancies for home birth patients will be covered; home births are expected to be uncomplicated.

ApplicabilityApplies to prenatal E/M services billed for home birth patients when related to high‑risk pregnancy care.

RationaleBCBSRI does not cover additional prenatal E/M for high‑risk pregnancies in the home birth setting because home births are expected to be uncomplicated.

Related billing ruleAll global maternity policies apply; providers may not bill prenatal care when another provider is billing prenatal services for the same period.

Provider Requirements and Authorization

Prior Authorization

Provider credentialing, notification, and liability insurance required; no prior authorization

Participating providers must notify Blue Cross Blue Shield of Rhode Island, be credentialed specifically for home births, and carry liability insurance that includes coverage for home births. Prior authorization is not applicable.

Notify BCBSRI of participation in providing home birth services.
Complete BCBSRI credentialing specifically for home births.
Maintain liability insurance that explicitly includes coverage for home births.
No prior authorization is required for home birth services.

Scope and Medical Criteria

Scope / Medical criteria (inv-05)

Medical criteriaNot applicable.

BackgroundNot applicable; overview states the policy documents coverage and BCBSRI payment policy related to home births.

ScopeGoverns BCBSRI coverage and payment rules for home births, including provider responsibilities and billing rules.