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Claims to Be Reprocessed to Align with Grouper Versions Effective February 16, 2024

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Effective February 16, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) and the Children with Special Health Care Needs (CSHCN) Services Program has implemented the All Patient Refined Diagnosis Related Groups (APR-DRG) Grouper 40 and 41 with specific dates of discharge. This update includes a change to the processing of inpatient claims.

The following APR-DRG Groupers were implemented with the following dates of discharge:

  • Effective for dates of discharge on or after April 1, 2023, inpatient claims will be processed in the APR-DRG system using Grouper version 38 logic and relative weights and mapped to version 40.1.
  • Effective for dates of discharge on or after September 1, 2023, inpatient claims will be processed in the APR-DRG system using Grouper version 40 logic and relative weights and mapped to version 40.1.
  • Effective for dates of discharge on or after October 1, 2023, inpatient claims will be processed in the APR-DRG system using Grouper version 40 logic and relative weights and mapped to version 41.

Note: Impacted claims will be reprocessed to capture the APR-DRG changes.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.