Maternal child services
New Baby, New LifeSM is a comprehensive, proactive case management and care coordination program for all expectant mothers and their newborns. It offers:
- Individualized, one-on-one case management support for women at the highest risk.
- Care coordination for moms who may need a little extra support.
- Educational materials and information on community resources.
- Incentives to keep up with prenatal and postpartum checkups and well-child visits after the baby is born.
This program helps identify pregnant women as early in their pregnancies as possible. Once pregnant members are identified, we act quickly to assess obstetrical risk and ensure appropriate levels of care‑management services to mitigate risk.
If you would like more information about the OB Case Management program or have a patient who would benefit from case management, call Provider Services at 844-521-6942.
Healthy Blue requires notification of pregnancy after the first prenatal visit and notification of delivery following birth. Our preferred method to complete the notification of pregnancy and delivery is by way of the online Interactive Care Reviewer (ICR) tool, which is available through your Availity account. You may also fax the forms to Healthy Blue at 1-877-269-5705.
We also encourage providers to complete the Maternity Module in Availity:
- Perform an Eligibility and Benefits request on an Anthem member.
- Choose one of the following benefit service types: Maternity, Obstetrical, Gynecological, Obstetrical/Gynecological.
- Before the benefit results screen, you will be asked if the member is pregnant. Choose Yes, if applicable, and note the estimated due date. You can leave this blank if the due date is unknown.
- After submitting your answer, the E&B will display. If the member was identified as pregnant, a Maternity form will now be available. You may access the form by navigating to the Applications tab and selecting the Maternity link.
After submitting your answer, you’ll be taken to the member’s benefits page. A Maternity Module will now be available for this member in the Payer Spaces section of Availity.
Call Provider Services
Fax the forms to Healthy Blue
My Advocate® program
As part of our maternal child services program, members are offered the My Advocate program. This program provides pregnant and postpartum women proactive, culturally appropriate outreach and education through interactive Voice Response (IVR). Eligible members receive regular calls with tailored content from a voice personality (Mary Beth) or they may choose to access the program via a smartphone application or website. This program does not replace the high‑touch case-management approach for high-risk pregnant women. However, it does serve as a supplementary tool to extend our health education reach.
Each automated My Advocate communication gives the member specific health care education in a warm, easy-to-understand fashion. Eligible members receive regular messages with tailored content from Mary Beth in English or Spanish. The topics include:
- Obstetric high-risk screening
- Maternal and child health:
- Prenatal care
- Postpartum care
- Well-baby care
For more information on My Advocate, visit myadvocatehelps.com.
Substance Use Disorders in Pregnancy and Neonatal Abstinence syndrome
Substance use disorders (SUDs) are on the rise and are of particular concern in women of childbearing age who are or may become pregnant. OB providers have a unique opportunity to help break the pattern of opioid misuse, thus, avoiding health consequences for both mother and child. The important steps in this practice are to identify, treat, and/or refer to treatment women who are using/abusing unhealthy substances. Healthy Blue is here to support providers, pregnant members, and their little ones on the way.
If you would like more information about the OB Case Management program or have a patient who would benefit from care management, call Provider Services at 844-521-6942.
Neonatal Intensive Care Unit Care Management Program
For parents with infants admitted to the neonatal intensive care unit (NICU), we offer the NICU Case Management program.
The stress of having an infant in the NICU can potentially result in Post-Traumatic Stress Disorder (PTSD) symptoms among parents and loved ones. In an effort to reduce the impact of PTSD among members, we assist by:
- Guiding parent(s) into hospital-based support programs, if available, as well as to target support services and referrals to providers
- Screening parent(s) for PTSD approximately one month after the date of birth
- Referring parent(s) to behavioral health program resources, if indicated
- Reconnecting with families with a one-month follow-up call to assess if the parent(s) received benefit from initial contact and PTSD awareness
If you would like more information about the NICU Case Management program or have a patient who would benefit, please call Provider Services at 844-521-6942.
To view and access forms related to pregnancy and maternal child services, please visit the Forms page.
- NAS Provider Toolkit
- Postpartum Mood Disorder Flier
- A provider’s guide to diagnosis coding for pregnancy
- New Baby, New Life provider booklet
- Prenatal Ultrasound Diagnosis (DX) Code Update
- New mother postpartum visit schedule
- Preventing preterm birth
- Safe prevention of primary cesarean delivery
- Postpartum Interventions for Maternal Morbidity and Mortality
- Maternal Cardiovascular Health Flier
- 2023 Prenatal Ultrasound Diagnostic Code List
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)