Update on Claims Reprocessing for DRG Groupers

Version 31 of the DRG Grouper was implemented in NCTracks on December 8, 2013 and non-state hospital rates were loaded on December 30. NCTracks will be reprocessing the relevant inpatient institutional claims filed between October 1 - the effective date of DRG Grouper version 31 - and December 31, 2013. Affected providers will see the reprocessed claims in a separate section of the paper Remittance Advice only for the April 8 checkwrite. The EOB associated with these reprocessed claims will be 06042 - "DRG Grouper Version 31 Adjustments".

Approximately two weeks after the April 8th checkwrite, NCTracks will be reprocessing the relevant inpatient institutional claims filed between July 1 and November 10, 2013, which is the date when version 30 of the DRG Grouper was implemented. Affected providers will see the reprocessed claims in a separate section of the paper Remittance Advice only for the April 22 checkwrite. The EOB associated with these reprocessed claims will be 06041 - "DRG Grouper Version 30 Adjustments".

The 835 transactions will include the reprocessed claims along with other claims submitted for the checkwrite. (There is no separate 835.)

Based on the application of the groupers, the reimbursement for the reprocessed claims may change. No action is required by providers.

The schedule for reprocessing the remaining claims for DRG Grouper version 30 and version 29 will be announced shortly.