HCA to Update Medicaid Inpatient Hospital Payment Grouper Version

January 17, 2018

On April 1, the Health Care Authority (HCA) will be updating the APRDRG grouper used for pricing Medicaid inpatient hospital claims from the current version 31 to version 33. Upon our request for information, WSHA has been told by HCA that they have done an extensive claims testing comparing payment of individual claims under both grouper versions and confirmed that the change will not result in changes to APRDRG classifications or severity levels. Therefore, this change should not impact the payment amount for claims. The change is to accommodate new ICD-10 codes created since the prior version and reduce the amount of “ungroupable claims” caused by the new codes.

HCA has also notified the Medicaid managed care plans regarding the change. HCA does not anticipate hospitals will notice any change in payment, other than a reduction in previously ungroupable claims. WSHA will continue to monitor the situation and asks hospitals to let us know if you encounter unexpected changes to payment from HCA or the managed care plans after April 1. (Andrew Busz, andrewb@wsha.org).


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