Hospital & Ambulatory Surgical Centers (ASCs) Solventum Fee-for-Service Grouper Updates– Effective July 1, 2024

Download PDF

Bulletin

September 9, 2024, 12:13PM

To:

All Providers and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program

From:

Cheryl J. Roberts, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to notify hospitals and Ambulatory Surgical Centers (ASCs) about the delay in updating the Solventum, formerly known as 3M, All Patient Refined Diagnosis-Related Group (APR-DRG) and Enhanced Ambulatory Patient Group (EAPG) versions and weights for state fiscal year 2025 (SFY25). This bulletin serves as an update to the July 8, 2024, bulletin titled “Inpatient and Outpatient Hospital Rates Effective July 1, 2024”.

Implementation of the new grouper version and weights has been delayed. Any fee-for-service claims submitted after the close of business September 9, 2024, will be processed at the rates published in the July 8, 2024, bulletin "Inpatient and Outpatient Hospital Rates Effective July 1, 2024".

Claims paid between July 1, 2024, and prior to the implementation of the updated grouper and weights will be automatically reprocessed on September 13, 2024. This action will be reflected in the remittance dated September 20, 2024. The Virginia-specific Diagnosis- Related Group (DRG) weights, as well as other inpatient reimbursement parameters, are available on the DMAS web site at https://www.dmas.virginia.gov/for-providers/rates-and-rate-setting/hospital-rates/.

If you have any questions pertaining to the rates processed for MCO claims, please contact the MCOs.

PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

https://vamedicaid.dmas.virginia.gov/

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996

Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

https://www.dmas.virginia.gov/appeals/

Managed Care Programs

Cardinal Care Managed Care and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Cardinal Care Managed Care

https://www.dmas.virginia.gov/for-providers/managed-care/cardinal-care-…

PACE

Program of All-inclusive Care (virginia.gov)

Acentra Health

Behavioral Health Services

https://vamedicaid.dmas.virginia.gov/sa

Provider Enrollment

In-State: 804-270-5105

Out of State Toll Free: 888-829-5373

Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com

Provider HELPLINE