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Alerts
  • Upgrades to the internal components of the ForwardHealth Portal were made on June 14, 2024. As a result, you may notice minor “look and feel” changes, but they will not impact features or functionality. If you encounter any issues, please reach out to the ForwardHealth Portal Help Desk.

  • Multi-factor authentication (MFA) is now required for the secure ForwardHealth Portal. Providers are encouraged to refer to the ForwardHealth Multi-Factor Authorization Instruction Sheet for help setting up MFA preferences.
    Providers may contact their Portal account administrator or call the ForwardHealth Portal Help Desk at 866-908-1363. Note: This is a project-specific announcement and is not related to the Change Healthcare disruption.
APR DRG

All Patient Refined Diagnosis Related Group

ForwardHealth uses the All Patient Refined Diagnosis Related Group (APR DRG) classification system to classify and calculate pricing for inpatient hospital claims, Medicare crossover claims, and HMO encounters with dates of discharge or "To" dates of service (DOS) on and after January 1, 2017. The APR DRG classification system will replace the Medicare Severity Diagnosis Related Group (MS-DRG) classification system. The MS-DRG classification system is still effective for inpatient hospital claims, Medicare crossover claims, and HMO encounters with dates of discharge or "To" DOS before January 1, 2017.

Please see here for a history of the previously used MS DRGs.

The APR DRG classification system:

  • Aligns the classification of inpatient hospital claims and HMO encounters more appropriately with the needs of the Medicaid, BadgerCare Plus, Wisconsin Chronic Disease Program (WCDP) – Adult Cystic Fibrosis, and WCDP – Chronic Renal Disease member populations.
  • Expands the DRG system scope to include patient severity of illness and risk of mortality levels.
  • Changes the pricing for inpatient hospital claims and HMO encounters for members enrolled in Wisconsin Medicaid and BadgerCare Plus.
  • Changes the pricing for inpatient hospital claims for members enrolled in WCDP – Adult Cystic Fibrosis and WCDP – Chronic Renal Disease, which were not currently priced using the MS-DRG classification system.
  • Excludes services provided to members enrolled in WCDP – Hemophilia Home Care.
  • Excludes reimbursement for services provided at rehabilitation and psychiatric hospitals, which will continue to be reimbursed per diem as they are currently.
  • Excludes services provided during certain types of hospital stays, including services related to ventilator care, certain unusual cases, and brain injury cases.
  • Excludes inpatient hospital services provided to Department of Corrections inmates at acute care hospitals.
ForwardHealth is using this Portal page for APR DRG information and resources. Providers and HMOs are encouraged to check this page regularly for updated information.

ForwardHealth Updates

2016-26 Implementation of the All Patient Refined Diagnosis Related Groups Classification System, 6/30/16
2016-36 Upcoming Trainings for the All Patient Refined Diagnosis Related Group System, 9/16/16
2016-43 Inpatient Hospital Pricing Changing to the All Patient Refined Diagnosis Related Group Classification System, 10/11/16

Email Subscription to Receive APR DRG Information

Additional Resources

  • Frequently Asked Questions
  • Present On Admission Map File
  • Wisconsin Medicaid DRG Pricing Calculator
  • Secure APR DRG Assignment program containing APR DRG versions, an APR DRG calculator, and the APR DRG Definitions Manual. Hospital providers should use the user name and password provided to them via their ForwardHealth Portal account to access this information.
  • Providers with fee-for-service APR DRG claims questions may email them to VEDSAPRDRGSupport@wisconsin.gov. Questions should not be sent in a secured format (e.g., Zix Email Encryption), because these messages cannot be opened for security reasons.
  • Provider Services: 800-947-9627

APR DRG Rates and Weights

APR DRG rates and weights that are effective on and after January 1, 2017, are published on the Hospital Rates and Weights Portal page.

Current System Information

Current version information and installation dates for the APR DRG Grouper, the 3M Grouper Plus Content Services (GPCS), and the EAPG grouper can be found on the Hospital Rates and Weights Portal page.

Training

ForwardHealth conducted provider training sessions on the APR DRG classification system in October 2016. The training presentations are available below.

Information for HMOs

ForwardHealth is communicating APR DRG information to HMOs at the monthly HMO Encounter Technical meetings; however, HMOs are encouraged to check this page regularly for updated information.

ForwardHealth has given HMOs the user ID and password needed to access the secure program, which contains APR DRG versions, an APR DRG calculator, and the APR DRG Definitions Manual.

HMOs with APR DRG encounter questions may email them to VEDSHMOSupport@wisconsin.gov. Questions should not be sent in a secured format (e.g., Zix Email Encryption), because these messages cannot be opened for security reasons.

 
 
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