Maternal child services

Maternity Module in Availity

We also encourage providers to complete the Maternity Module in Availity :

1. Perform an Eligibility and Benefits request on a member enrolled in Wellpoint.
2. Choose one of the following benefit service types: maternity, obstetrical, gynecological, obstetrical/gynecological.
3. 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, 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.

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. Wellpoint is here to support providers, pregnant members and their little ones on the way. 

For more information about the OB Case Management program or if you have a patient who would benefit from case management, please contact Provider Services.

My Advocate^® program

As part of our program, members are offered access to My Advocate. This program provides pregnant and postpartum women proactive, culturally appropriate outreach and education through interactive voice response, smartphone application or website. 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, postpartum and well-baby care)

Feel free to visit the My Advocate website for more information.

Neonatal Intensive Care Unit (NICU) Case Management program

The NICU Case Management program is committed to ensuring that all of our high-risk infants have a well-defined plan for quality and cost effective NICU care and a safe and successful transition to the home environment. We provide a seamless, integrated approach, including early identification of members for NICU Care Management referral, enrollment, engagement and continued oversight through case closure.

Our program encourages parent/caregiver involvement in their infant’s care while hospitalized in the NICU. We focus on parents of infants expected to be in the hospital greater than two weeks who were born at 34 or fewer weeks gestation, born weighing 2000 grams or less, born with major congenital anomalies, require ventilator care, or require major surgery. We provide education and support designed to help them cope with the day-to-day stress of having a baby in the NICU, encourage them to stay involved in the care of their babies and help them prepare themselves and their homes for discharge.

The stress of having a critically ill 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 our 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 from care management, please contact Provider Services.