Quality Health Standards –Prenatal and Postpartum Visits

December 23, 2020

Blue Cross and Blue Shield of New Mexico (BCBSNM) needs your assistance in improving prenatal and postpartum visits.

  • Members who have been recently become pregnant should establish care with an obstetric provider, especially during the first 12 weeks of pregnancy.
    • Documentation indicating the woman is pregnant or references to the pregnancy; for example:
      • Documentation in a standardized prenatal flow sheet
      • Documentation of LMP, EDD or gestational age
      • A positive pregnancy test result
      • Documentation of gravidity and parity 
      • Documentation of complete obstetrical history
      • Documentation of prenatal risk assessment and counseling/education.
    • A basic physical obstetrical examination that includes auscultation for fetal heart tone, or pelvic exam with obstetric observations, or measurement of fundus height (a standardized prenatal flow sheet may be used).
    • Evidence that a prenatal care procedure was performed, such as:
      • Screening test in the form of an obstetric panel (must include all the following: hematocrit, differential WBC count, platelet count, hepatitis B surface antigen, rubella antibody, syphilis test, RBC antibody screen, Rh and ABO blood typing)
      • TORCH antibody panel alone
      • A rubella antibody test/titer with a Rh incompatibility (ABO/Rh) blood typing
      • Ultrasound of a pregnant uterus.
  • Members should have a postpartum visit between 7 and 84 days after delivery. Documentation in the medical record must include a note indicating the date when a postpartum visit occurred and one of the following:
    • The provider name, credentials and date of prenatal and postpartum care visit
    • Documentation of a pelvic exam and assessment of weight, blood pressure, breasts, and abdomen
    • Documentation of a perineal or cesarean incision/wound check, if applicable
    • Documentation of a screening for depression, anxiety, tobacco use, substance use disorder, or preexisting mental health disorders, if completed during postpartum visit
    • Documentation of glucose screening or women with gestational diabetes, if completed during visit
    • Documentation of any of the following topics, if discussed during the postpartum visit:
      • Infant care or breastfeeding
      • Resumption of intercourse, birth spacing or family planning
      • Sleep/fatigue
      • Resumption of physical activity
      • Attainment of healthy weight.
  • Encourage participation in BCBSNM maternity program – members may call the customer service number on the back of their ID card for more information.
  • For Centennial Medicaid Members only, promote BCBSNM's Value-Added Services: members can receive a crib, car seat, and/or a baby carrier wrap at no cost. To qualify for these rewards, members must participate in the maternity program and complete certain prenatal/postpartum care visits requirements to receive these reward(s). More information and downloadable forms are available on the BCBSNM Centennial Care website.
  • For Centennial Medicaid Members only, promote the Centennial Rewards program – members can earn additional rewards by completing prenatal and postpartum visits. Members are encouraged to see earned rewards by visiting the Centennial Rewards Learn more about third-party links website or by calling 1-877-806-8964.
  • Consider assisting the member in scheduling a well child checkup for their newborn.

Recently, the National Committee on Quality Assurance (NCQA) allows telephone visits, e-visits, and virtual check-ins as meeting the criteria for both prenatal and postpartum care visits.

If you have questions or would like to request additional information, please call BCBSNM Quality Department at (855) 699-0042.