MedicaidPrior AuthMedium impact
Billing Clarification for Diagnosis Related Groups (DRG) Facilities
Alaska Medicaid·AK·Billing & Coding
Effective date
Feb 1, 2025
We identified it
Jun 21, 2026
Summary
Alaska Medicaid has updated DRG facility billing requirements effective February 1, 2025. Authorization is no longer required for continued stays exceeding 3 days for inpatient claims with discharge dates on or after 02/01/2025, unless the diagnosis or procedure is on the Alaska Medicaid Prior Authorization List. New interim billing rules are established for partial month eligibility and stays exceeding 60 days.
Action Required
By February 1, 2025: Billing teams at Alaska DRG facilities must update authorization workflows to stop requiring prior auth for continued stays over 3 days, except for diagnoses/procedures on the Alaska Medicaid Prior Authorization List. Update billing system rules for interim billing: allow only for partial month eligibility and 60+ day stays. For 60+ day stays, use type of bill xxx2 with discharge status 30 for initial 60-day claims, then adjust to include additional days. For awaiting placement scenarios, bill inpatient days separately from placement days using discharge status 61 or 70.