Our Solution
As your trusted partner, we support your members at every stage of the maternity journey
Personalized support is more than a buzzword. Our multi-modal, whole-person approach supports the mother and newborn at every stage of the pregnancy by tailoring the resources, modalities, and contact frequency needed to meet the individual’s unique needs.
Watch VideoIt’s not the destination; it’s the journey.
We call it the continuum of care.
From prenatal health, through a possible NICU stay, to one full year of life, we work with payers, physicians, members and their families to ensure the best possible outcome for every expecting mother.
Maternal Health
NICU Infant Health
Payment Integrity
Maternity Case Management
We support your members through pregnancy and for an entire year after delivery.
We closely connect with women to act as trusted advocates – identifying risks, solving for needed resources, and offering educational and emotional support.
Early Identification
Our platform identifies risk early to help reduce pre-term births, NICU stays, and complications during and after delivery.
Case Management
Our case managers help address medical and non-medical health risks, create personalized care plans, and leverage trusted relationships throughout the maternal continuum, ensuring a proactive and comprehensive approach to case management.
Solving Social Determinants of Health
Maternity and NICU Case Managers proactively identify non-clinical risk factors and solve these gaps to help reduce their impact on maternal and infant health outcomes.
NICU Utilization & Case Management
In the event of a NICU admission, we support the infant and family at every step
We support your newborn member, mother, and family through every critical milestone. Our dedicated NICU Utilization Management team works closely with facility staff and leverages our predictive analytics platform to ensure your members receive the appropriate clinical care.
At the same time, our NICU Case Management team works with mothers and families to provide the critical support they need during stressful times.
Together, our UM and CM teams support your members and their families – during the NICU stay and for one year beyond – driving improved outcomes, enhancing the physician and member experience, and lowering the overall cost of care.
Learn MoreNICU Payment Validation & Assurance
Uncover lost savings related to NICU claims
NICU cases drive some of the highest rates of unwarranted spending. Our NICU Payment Validation & Assurance program reviews 100% of all NICU claims and flags the twenty to thirty percent with billing inconsistencies.
NICU Claims Review
We review 100% of NICU claims to identify overpayments and inaccurate billing through automated technology, internal UM authorization data, and our Baby Trax® platform clinical data.
Specialized physicians and certified medical coders perform our hands-on review.
NICU Claims Processing
ProgenyHealth applies a hybrid approach that combines automated technology with a hands-on review that compares the rationale for the coding against the clinical notes and authorized services that form the basis of a claim.
Utilization Management Integration
Our integrated approach leverages UM, CM, in-house claims data, and specialized clinical expertise to deliver the speed, volume, and accuracy needed for true NICU payment integrity.
Our payment is contingent on identified savings – if there are no findings, there is no cost.
“ProgenyHealth has been an outstanding partner…”
“Their clinical expertise in the NICU arena has helped us to manage the care of these infants effectively, and they are completely committed to identifying and addressing the social determinants of health often found in this fragile population.”
Marge Angelio, Amerihealth Caritas’ Market President
Read the Overview:
ProgenyHealth Overview
Only ProgenyHealth brings personalized maternity case management, NICU utilization and case management, and NICU payment integrity – all under one roof.
We are your trusted partner for better outcomes
Let us help manage your members’ maternity journeys from pregnancy to one year postpartum.