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Revised Diagnostic Related Group Coding Reviews pdf

Connecticut Medicaid (HUSKY Health)·CT·Coding
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

Connecticut Medicaid has updated its DRG coding review process for inpatient hospital claims, changing from full recoupment to partial recoupment for overpaid claims. Claims identified through HMS reviews will now have adjusted payments rather than full recoveries, with specific ICN and EOB codes for tracking.

Action Required

Action needed
Immediately: Billing team should monitor remittance advice for ICN codes beginning with region code 60 'HMS Adjustment' and EOB code 8228 for DRG coding review adjustments. Update claim reconciliation processes to identify CARC 16 and RARC N208 codes on 835 files indicating DRG coding issues. Consider registering for HMS Provider Portal at CT_Medicaid_State@hms.com or 1-866-206-6855 for streamlined review communication.

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