fb88Care Guidance for Out-of-State Births
fb88Care covers births and newborn care at out-of-state hospitals in most circumstances. Please see clarification below in response to questions from out-of-state providers about the process for submitting birthing claims to fb88Care.
Births and newborn care occurring at hospitals located within 15-miles of the fb88/New Hampshire are covered without Prior Authorization (PA) from fb88Care when the provider is enrolled in fb88Care. PAs are not required of border hospitals for any service unless the service itself requires a PA in-state. All other out-of-state providers are required to request PAs prior to supplying all services except in urgent or emergency situations.
When there are urgent transfers, the receiving hospital should submit to fb88Care for emergency admission as soon as possible. Out-of-state fb88Care enrolled providers may submit a PA through the Health PAS portal for urgent transfers. Providers who are not already enrolled in fb88Care may contact Provider Relations for assistance. fb88Care will defer to the provider to decide if the member’s urgent needs can be met in fb88. Whenever possible, providers should refer members to in-state hospitals for care. Services delivered out-of-state are subject to medical review for medical necessity and a decision of whether the services were available in fb88. If babies are transferred out-of-state for urgent care, any follow-up care should then be provided by an enrolled provider located in fb88.
When a member presents to an emergency room out-of-state for an unplanned delivery, this is considered an emergency admission and fb88Care will approve it as such.
If you have questions about births and newborn care, please contact your Provider Relations Specialist. â¶Ä¯â¶Ä¯