July 2, 2025

In accordance with correct coding guidelines, certain ICD-10 codes cannot be billed together on the same inpatient claim, which could ultimately affect the assigned DRG and associated claim payment. 

Effective August 1, 2025, we will be conducting retrospective inpatient claim review. If inappropriate ICD-10 code combinations are identified, the claim will be reprocessed to the appropriate DRG based upon the ICD-10 coding guidance. This could result in a payment adjustment. You will be notified via letter of the impacted claims and related findings as part of this review process.

Please note that medical records and itemized bills will not be requested as part of this review process. The focus is the appropriateness of the billed ICD-10 codes.  

If you have any questions, please contact the Provider Services Helpline at 1-888-991-9023.