Reconciliation due to rate updates: acute DRG, exempt hospitals, and exempt hospital unit services

We are required to adjust rates in accordance with the acute Diagnosis-Related Groups (DRGs), exempt hospitals, and exempt hospital unit services payment methodology, retroactive to the effective date of those rates as determined by the New York State Division of Budget. As a result, rates issued by the state in September 2024 will be applied retroactively to all claims submitted with dates of discharge on or after April 1, 2024.

Accordingly, we will reconcile the affected claims and determine the adjusted reimbursement amounts based on the new rates. If, based on our reconciliation efforts, you are due additional reimbursement, we will issue payment at that time. If the adjusted net reimbursement results in an amount due from you to us, we will commence recovery of such amounts through an offset against future claims payments.

We appreciate your continued participation in our network. If you have any questions, contact Provider Services at 800‑450‑8753.