Medical Necessity Review
NBAS’s Medical Necessity Review is an effective tool for post-service, pre-payment claims where medical necessity is in question. NBAS validates that billed services and supplies were appropriate and essential for treatment based on CMS guidelines and other nationally published and recognized criteria developed by the FDA, AMA, MCG (formerly Milliman), National Cancer Institute, and other similar specialty organizations.
Experimental or Investigational Review
NBAS’s Experimental and/or Investigational Review ensures that billed procedures, technology, and pharmacology that are considered experimental and/or investigational in nature are identified and addressed by a board certified physician prior to claim adjudication.
Level of Care Review
NBAS’s Level of Care Review identifies inconsistencies between the patient’s admission level and continued stay in conjunction with the patient’s clinical records. Supported by industry standard guidelines, NBAS determines if the confinement level was appropriate based on the patient’s diagnosis and the services rendered. In addition, discharge criteria is reviewed to ascertain if the patient could have been discharged on an earlier date.