Note: This article applies only to claims submitted to TMHP for processing. Refer to the Medicaid managed care organizations (MCOs) for information about MCO benefits, limitations, prior authorization, reimbursement, and MCO specific claim processing procedures.

Effective for dates of discharges on or after November 1, 2016, Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program will use version 34 of the All Patient Refined-Diagnosis Related Groups (APR-DRG) system to process inpatient claims.

Statistical information about the APR-DRG payment system, which includes relative weights, mean length of stay, and day thresholds, will be available on the Texas Medicaid Acute Care Hospital Reimbursement web page by October 31, 2016.

For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.

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