21-039 Send Birth Event Clinical Records When Requested

Date: 01/15/21

This information applies to Hospitals and Ancillary providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.

Additional information may be required to support the birth event

When the plan receives an inpatient notification of delivery you may receive a request from the Case Management Department to send the below information.

• Newborn’s name 
• Birth date and time   
• Birth order if multiples  
• Delivery type
• Age
• Gender
• Weight (pounds, ounces or grams)
• APGAR – 1 and 5 Minute
• Birth status:
  • Healthy/home with mom
  • Healthy/adopted or foster care
  • Sick – hospitalized
  • Detained/border baby
  • Expired 

Submit clinical documentation within one business day from receipt of the request via fax at 1-855-556-7909.

Additional information

For questions about the request form, contact the Case Management Department at 1-866-801-6294, press option 2.