July 18, 2025
Effective Sept. 15, 2025, we’ll pay for the authorized level of neonatal intensive care units in your prior authorization. This change applies to most commercial members.
What this means for you: If the level of care authorized doesn’t match the level of care billed, this will result in a reduction in payment for that line of service. If we reduce payment of your claim, you may submit a reconsideration for a post-service medical necessity review to consider reimbursement at a higher level of care than initially authorized.
Always check eligibility and benefits first through Availity® Essentials or your preferred vendor, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Refer to utilization management for more information.
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