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NICU Claims Review
Reduce overpayments from unauthorized claims and incorrect billing
Our NICU Claims Review (NICU Payment Validation & Assurance) solution identifies overpayments by combining data technology with a hands-on claims review performed by NICU clinicians and certified coders.
We uncover similar discrepancies for both commercial and Medicaid plans that can result in significant overpayments if not identified.
By the Numbers: NICU Claims Review
80%
of all NICU claims have some degree of inaccuracy
28%
of ProgenyHealth reviewed claims have identified overpayments
$7K – $10K
Average recovery per finding
$1K – $3K
Average recovery per NICU-managed member
Claims Review & Validation
We review every NICU claim to verify approved days and levels of care based on what has been clinically authorized. We use clinical validation of diagnosis codes as the rationale for all billing adjustments.
Length of stay
We verify the number of days billed versus days authorized.
Level of care
We assure you that billed charges match the clinical levels of care authorized.
Diagnostics severity
We review the severity of illness with 300+ targeted codes to ensure coding accuracy.
Our proprietary access to underlying clinical data delivers unparalleled speed and accuracy
Our NICU Claims Review staff includes nurses with NICU clinical backgrounds to recognize errors quickly.
We match each claim to the clinical information obtained during concurrent NICU Utilization Management review, eliminating the need to request the entire medical record. This reduces administrative burden and physician abrasion.
We thoroughly document any findings, including a detailed explanation and rationale for any recommended adjustments.
Protect yourself from the costs and risks of inaccurate claims
80% of all claims have some degree of inaccuracy, such as inconsistencies with coding rules or not clinically validated. We enable overpayment recovery that can be strategically redirected, including improving the quality of care, increasing clinical and management efficiency, providing better coverage for the underinsured, and reducing the financial burden for families.
Identify NICU overpayments and overbilling that other payment integrity programs often miss
Most payment integrity programs focus on high-dollar claims, but NICU claims are not all high-dollar. Progeny Health observes that around 28% of NICU claims are inconsistent with authorized services or lack support from medical records.
We identify discrepancies of $7,000 to $10,000 on average per finding, representing $1,000 to $3,000 per NICU member managed (Results vary by client and market).
As your NICU Care Management partner, Progeny Health’s NICU Claims Review team reviews 100% of NICU claims.
Read our FAQ:
NICU Claims Review
Discover how our collaborative approach helps reduce physician abrasion and identify overpayments or overbilling for your organization.
Ready to identify overpayments in your NICU claims review?
Schedule a time to learn how we optimize NICU claims reviews for plans like yours.