Provider FAQs

BCBSNE is pleased to partner with ProgenyHealth, a leader in neonatal care management services, to enhance support for premature and medically complex newborns. This partnership strengthens care coordination and advances our shared commitment to improving health outcomes for members and families.

The partnership begins May 4, 2026.

The ProgenyHealth neonatal care management program applies to eligible BCBSNE members with premature or medically complex newborns who require NICU-level services.

ProgenyHealth brings a specialized team of neonatologists, pediatricians and neonatal nurse care managers who collaborate closely with attending physicians and hospital staff. This proactive model supports evidence-based care, timely discharge planning and improved neonatal outcomes.

Families are supported by a dedicated case manager who provides education and guidance throughout the program. Families also have 24/7 access to an on‑call clinical team to address concerns and support continuity of care.

For hospitals, ProgenyHealth serves as a care management partner by providing inpatient review services and supporting discharge planning to help ensure a smooth transition from the hospital to the home setting.

To learn more about ProgenyHealth programs and services, visit ProgenyHealth. BCBSNE thanks you for your continued partnership in caring for our members and supporting healthy outcomes for newborns and their families.

Providers should access NaviNet^® to locate and review member information.

Steps:

• Log in to NaviNet.
• Search for the subscriber or member using available demographic information.
• Navigate to the Benefits and Eligibility section.

A newborn may not yet be added to the plan. Using subscriber information allows providers to review how benefits apply under the policy.

Providers must determine whether the newborn qualifies for automatic 31‑day coverage.

The Benefits and Eligibility page in NaviNet will indicate:

• Whether the newborn qualifies for free automatic 31‑day coverage, or
• Whether the newborn must be formally added to the plan by the employer group.

Eligibility should be confirmed before submitting any notifications or authorization requests.

Once eligibility is confirmed, providers must review the Benefits and Eligibility section in NaviNet to determine whether the member is enrolled in the ProgenyHealth program.

Enrollment status is displayed when a member is in session. This step is essential because notification and authorization workflows differ based on ProgenyHealth enrollment.

Effective May 4, 2026, providers must notify ProgenyHealth directly of:

• NICU admissions, or
• Admissions to special care nurseries related to NICU‑level services.

Notifications should be submitted by fax to 800‑540‑9492. ProgenyHealth clinical staff will partner with your designated hospital team to provide utilization management support and assist with discharge planning throughout the inpatient stay.

Yes. If an infant is admitted to the NICU at birth and managed by ProgenyHealth, any subsequent NICU‑related admissions during the first year of life should continue to be directed to ProgenyHealth.

If the member is not enrolled:

• Follow standard BCBSNE notification and utilization management processes.
• If the member cannot be located in NaviNet after eligibility review, submit a Universal Prior Authorization Request Form.

If a Universal PA Request Form is submitted for a member who is enrolled in ProgenyHealth, the request will not continue through BCBSNE. The provider will be redirected to submit the notification directly to ProgenyHealth.

A child under one year of age who was not admitted to the NICU at birth is managed by BCBSNE using standard processes, regardless of whether ProgenyHealth applies.

Beginning June 1, 2026, ProgenyHealth will perform retrospective payment validation and assurance on previously paid claims within a two‑year lookback period or in accordance with applicable BCBSNE provider contracts.

Retrospective validation applies only to claims associated with NICU admissions that occurred prior to the ProgenyHealth go‑live date of May 4, 2026.