Effective for dates of discharge on or after January 1, 2017, ForwardHealth will implement the All Patient Refined Diagnosis Related Group (APR DRG) classification
system. Group Health Cooperative of Eau Claire will be implementing at the same time. This system will classify and calculate pricing for inpatient hospital claims.
This implementation will impact reimbursement for inpatient hospital services provided to members enrolled in Wisconsin Medicaid, BadgerCare Plus, and Wisconsin Chronic
Disease Program. The APR DRG system will replace the current Medicare Severity Diagnosis Related Group (MS-DRG) classification system. The MS-DRG remains in effect
for inpatient claims for dates of discharge before January 1, 2017.
For newborn inpatient claims beginning January 1, 2017, providers will be required to submit newborn birth weight in grams using Value Code 54. If the birth weight is not
submitted, claims will be denied back to the provider for resubmission to include the birth weight.
Services which are currently exempt from the DRG classification will continue to be exempt under the APR DRG classification system.
For additional information, please see ForwardHealth Update, June 2016, No. 2016-26, "Implementation of the All Patient Refined Diagnosis Related Groups Classification System", July 2016, No. 2016-31 – "Policy Regarding Submission of Hospital Claims for Births" and October 2016, No. 2016-43, "Inpatient Hospital Pricing Changing to the All Patient Refined Diagnosis Related Group Classification System."
If you have any questions or concerns, please contact Stacey, Janice or Carol in Provider Relations at (715)552-4300.