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Diagnostic Related Group (DRG) Coding Reviews pdf
Connecticut Medicaid (HUSKY Health)·CT·Coding
We identified it
Jun 20, 2026
Summary
Connecticut DSS will begin conducting post-payment reviews of inpatient hospital DRG claims through contractor HMS to ensure proper reimbursement. Hospitals must cooperate with medical record requests or face payment recoupment, and improperly paid claims will require full recoupment and resubmission with corrected coding.
Action Required
Immediately: Connecticut hospitals must prepare for DRG coding reviews by ensuring complete and accurate medical records are readily available for HMS requests. Establish process to respond timely to medical record requests to avoid automatic recoupment. Train coding staff on proper DRG assignment and documentation requirements. Monitor for HMS communications and utilize their online provider portal when available.