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Inpatient Claims with Ungroupable Diagnosis-Related Group to Be Reprocessed

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The Texas Medicaid & Healthcare Partnership (TMHP) and the Texas Health and Human Services Commission (HHSC) have identified an issue with some inpatient claims submitted between April 1, 2025, and May 15, 2025. The affected claims were incorrectly assigned an ungroupable diagnosis-related group (DRG).

To correct this issue, TMHP has updated the Grouper Plus Content Services software. TMHP will identify all affected inpatient claims submitted between April 1, 2025, through May 15, 2025, for reprocessing. Any reimbursements will be reflected in future Remittance and Status (R&S) Reports.

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