Change effective March 1, 2020: For Medicare Advantage members who are admitted to an Acute Inpatient Hospital (only non-critical access hospitals):  Approved initial inpatient reviews will be authorized for a DRG (diagnosis related group) payment rather than a goal length of stay which will eliminate routine concurrent reviews. Outlier payment requests will be reviewed for medical necessity after the claim is received and before payment is made. Additional education and process review will be attempted with individual facilities prior to the effective change date.

If you have additional questions, please feel free to contact your Provider Service Representative.