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Some Hospital Claims Will Be Reprocessed Due to Either Incorrect APR-DRG or SOI Levels

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The Texas Medicaid & Healthcare Partnership (TMHP) and Texas Health and Human Services Commission identified an issue that caused either incorrect All Patient Refined Diagnosis Related Groups (APR-DRG) or incorrect Severity of Illness (SOI) levels to be assigned to some inpatient hospital claims. Because of this issue, some claims were paid incorrectly.

TMHP will reprocess the affected claims with status dates on or after June 1, 2023, as necessary to capture the correct APR-DRG and/or SOI.

TMHP is analyzing the dates of these claims to make appropriate systematic changes.

For more information, call the Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.