NICU Payment Validation & Assurance
Pay the claims you owe, not the ones you donʼt
Our hybrid approach to NICU payment integrity delivers ongoing savings by combining automated technology with a hands-on claims review performed by NICU clinicians and certified coders.
Claims Reviews & Validation
We review every claim to verify approved days and levels based on what has been clinically authorized. We use DRG and Clinical Validation 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 100+ targeted codes (3M®APR DRG) to eliminate upcoding.
Our proprietary access to underlying clinical data delivers unparalleled speed and accuracy
Our Payment Validation & Assurance staff have NICU clinical backgrounds to recognize errors quickly.
Validations are processed in one or two days, unlike traditional payment integrity firms, which can take 30 days or more.
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 tax 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 eliminate physician abrasion and identify savings for your organization.
Questions about your claims review?
Schedule a time to learn how we optimize NICU claims for reliability and savings for plans like yours.