Effective 12/01 2021, members admitted to an Acute Inpatient Hospital where payment is based on a DRG (diagnosis related group):
Approved initial inpatient reviews will be authorized for a DRG payment rather than a goal length of stay. This will eliminate routine concurrent reviews. After the claim is received and before payment is made, outlier payment requests will be reviewed for medical necessity.
Please reach out to Health Services at email@example.com with any questions.