News
Internal Diagnosis-Related Group (DRG) Audit
Date: 06/12/24
Thank you for your continued partnership with NH Healthy Families, Ambetter from NH Healthy Families, and Wellcare from NH Healthy Families. As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities.
We are writing today to inform you of an additional review process that will taking place beginning on or after 8/10/2024.
| Description | Lines of Business |
|---|---|
| Inpatient claims will be reviewed internally for DRG validation prior to utilizing external vendors. Medical records will be requested for selected claims and should be sent according to the instructions on the request correspondence. | NH Healthy Families, Wellcare, Ambetter |
Sincerely,
NH Healthy Families
Ambetter from NH Healthy Families
Wellcare from NH Healthy Families