NBAS’s Neonatal Intensive Care Unit (NICU) Review is an effective tool for post-service NICU claims which frequently represent significant financial exposure. Through the review process, NBAS’s skilled registered nurses and panel of board certified physicians use multiple resources to determine if the care provided was medically necessary. NBAS also evaluates billed procedures, technology, and whether pharmacology may be considered experimental and/or investigational in nature and if duplicate charges, unbundled services and coding errors are present. NBAS validates that billed services and supplies were appropriate and essential for treatment based on nationally published and recognized criteria developed by the FDA, AMA, MCG (formerly Milliman), and other similar specialty organizations.
NICU CLAIM FACTS
Over the past 25 years, preterm births have increased more than 35%. Today, about one preterm infant is born every minute in the United States. The per-case cost of NICU care is among the highest that a health plan will face in its membership. This cost impact is compounded by the fact that most children’s hospitals offer very weak PPO discounts -10% or less – due to the lack of competition for their area of specialty. On average, care for infants in NICU settings accounts for 75% of all dollars spent for newborn care.