July 31, 2026
Beginning Nov. 2, 2026, reconsideration requests for finalized neonatal intensive care unit commercial claims assigned an ineligible reason code of CR1 must be filed within 180 days from the claim finalization date. This timeline applies to requests for postservice medical necessity review seeking reimbursement at a level of care higher than initially authorized.
What is CR1: The ineligible reason code CR1 is assigned to NICU inpatient hospital claims when the level of care authorized doesn’t match the level of care billed, resulting in a reduction in payment for that line.
Supporting documentation: If you submit a reconsideration within 180 days for a CR1 postservice medical necessity review to consider reimbursement, include the following medical records with your submission:
- Itemized bill
- Admission summary
- Discharge summary
- Daily progress notes
You can review your claim status through the Availity® Essentials Claim Status Tool. If you aren't registered, go to Availity Essentials and select Get Started to complete the guided online registration process at no cost.
For additional information, refer to Claim Review Process.
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