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NICU Payment Validation & Assurance

Increase your savings by reducing unauthorized claims and incorrect billing

Our hybrid approach to NICU payment integrity delivers ongoing savings by combining data technology with a hands-on claims review performed by NICU clinicians and certified coders.

Claims Reviews & 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 eliminate upcoding.

Our proprietary access to underlying clinical data delivers unparalleled speed and accuracy

Our Payment Validation & Assurance 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 the 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

We deliver savings 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.

Capture the savings that payment integrity programs often miss

Most Payment Integrity programs focus on high-dollar claims, but NICU claims are not all high-dollar. ProgenyHealth observes that around 20% to 30% of NICU claims are inconsistent with authorized services or lack support from medical records.

As your NICU Care Management partner, ProgenyHealth’s Payment Validation & Assurance team reviews 100% of NICU claims, serving as either your primary payment integrity partner or a secondary expert resource.

Read our Whitepaper:

NICU Payment Validation & Assurance

Discover how our collaborative approach to payment integrity helps reduce physician abrasion and identify savings for your organization.

Ready to increase your NICU claims savings?

Schedule a time to learn how we optimize NICU claims for reliability and savings for plans like yours.