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Obstetrical Needs Assessment Form (OBNAF)

Obstetrical Needs Assessment Form (OBNAF)

The Department of Public Welfare (DPW) developed and implemented a statewide Obstetrical Needs Assessment Form (OBNAF).  All practitioners rendering obstetrical care to MA recipients, including those enrolled in a PH-MCO like Gateway HealthSM (Gateway) must use the new form for any new pregnancies as of February 1, 2012.

Working collaboratively to improve outcomes! 

The healthy outcome of a Gateway member’s pregnancy involves a core team of at least 5 – the provider, the member, the Insurance Company, Home Health Agencies and outside resources.  With all working together with the medical assistance member, it provides an opportunity to advise the member to seek immediate medical care to prevent adverse outcomes.  Timely submission of the OBNAF to our Maternal Outreach and Management (MOM Matters®) program is critical in the early identification and intervention of high risk pregnancies.

How to access and submit the OBNAF?

For easy access and completion we have made the OBNAF form an editable PDF and available to our OB provider network. Just click on the PDF, update and print a copy for submission to Gateway and to retain in the patient’s medical record.  In addition, the Obstetrical Needs Assessment Form (MA form # 552) is available on the Department of Public Welfare’s website at: www.dpw.state.pa.us/findaform/ordermedicalassistanceforms/index.htm.

A copy of the OBNAF can be scanned and submitted via Gateway’s secure email Messaging Center by clicking here.  You must Register if you are a new user by simply entering your email address and a password.  Once you are Registered you can begin sending completed OBNAFs directly to Gateway’s MOM Matters® staff.  To ensure confidentiality OBNAFs may only be emailed to Gateway via our Messaging Center.  You still have the option of faxing the OBNAF if you prefer.  The fax numbers are (412) 255-5639 or 1-888-225-2360.  Please submit the OBNAF via either option within 30 days of the Intake Visit.

Billing Guidelines:

The first visit with an obstetrical patient is considered the Intake Visit, or if a patient becomes a Gateway member during the course of her pregnancy, her first visit as a Gateway member is considered to be her Intake Visit.  At the Intake Visit, an OBNAF must be completed.

While the OBNAF is not a claim form, it must be received by Gateway in order to process your claim for the first trimester bonus payment and initial Intake Visit.  Click here to view the OBNAF & OBSTETRICAL CARE BILLING GUIDE.

Any questions you may have regarding completion of the OBNAF contact Gateway’s MOM Matters® staff at 1-800-392-1147.  Please contact Gateway’s Provider Services Department at 1-800-392-1147 or your Provider Relations Representative with any billing inquiries.

 

Forms require the Adobe Acrobat Reader installed on your system. Most computers have this program installed. If it is not installed on your computer, you can download it for free from Adobe.