Newborn and circumstances | RaneemHCP wireframes

NPHIES needs all 7 mother details. Fix 3 mother fields before you continue: Mother's Member ID, Mother's Birth Date and Mother's Marital Status.

More than 90 days since birth. The baby is 107 days old. NPHIES accepts a newborn claim only within 90 days of birth. Check the date of birth, or send the claim under the baby's own ID.

Deceased patient

Patient is deceased

Deceased Date (optional)

Optional: date the patient died.

Transfer

Patient is being transferred

Transferring From Provider License

Newborn and mother

Patient is a newborn

Baby date of birth

Same as Date of Birth on Patient identity. 48 days old. Send the claim by 2026-11-16 (90 days).

Baby date of birth

107 days old. The limit is 90 days.

Birth Weight (kg) (optional)

Mother's Information

All 7 mother details are required: Member ID, ID Type, First Name, Last Name, Birth Date, Marital Status and Occupation.

Mother's Member ID

Mother's ID Type

Mother's First Name

Mother's Middle Name (optional)

Mother's Last Name

Mother's Birth Date

Mother's Religion (optional)

Mother's Marital Status

Mother's Occupation

Mother's Member ID

Required by NPHIES.

Mother's ID Type

Mother's First Name

Mother's Middle Name (optional)

Mother's Last Name

Mother's Birth Date

Required by NPHIES.

Mother's Religion (optional)

Mother's Marital Status

Required by NPHIES.

Mother's Occupation

Newborn claims must be sent within 90 days of birth. Marital Status and Occupation are not required for the newborn.

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