Normal newborn diagnosis-related group claims processing update

Effective November 1, 2018, Empire BlueCross BlueShield HealthPlus (Empire) will update the claims processing system to ensure accurate payment of newborn claims in accordance with New York normal newborn diagnosis-related group (DRG) requirements and Empire’s inpatient authorization requirements.

 

All newborn inpatient stays must have sufficient documentation provided to support an admission to an area beyond the newborn nursery, such as a neonatal intensive care unit (NICU) or for the higher level of care associated with the more complex newborn DRG. Documentation to support the higher level admission includes authorization or medical records.

 

Failure to provide the appropriate documentation will result in the claim being processed based on the normal newborn rate. Please note that current authorization guidelines for normal newborn and higher level of care baby inpatient stays will be applied.

 

For more information about this update, please go here.