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Obstetric Policy Adjustor on DRG Claims Will Be Reprocessed

June 30, 2016

A previous NewsFlash article identified a claims processing issue that prevented the 1.06 obstetric policy adjustor from applying to all diagnosis-related group (DRG) obstetric claims with admissions for dates of service on or after of July 1, 2015. This issue was resolved on November 23, 2015.

Post-implementation analysis indicated that claims are now correctly pricing with the 1.06 obstetric policy adjustor. Affected claims will be reprocessed via an Erroneous Payment Correction (EPC) as follows:

Claims erroneously priced from July 1, 2015, through November 23, 2015, will be reprocessed in November 2016

Providers are not required to take any action, but should continue to submit claims timely. Providers are encouraged to check the Medi-Cal website or the Diagnosis Related Group Hospital Inpatient Payment Methodology page of the Department of Health Care Services website regularly for updates regarding this issue.