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MedicaidReimbursementMedium impact

KMAP BULLETIN: New DRG Grouper for April 2025

Kansas Medicaid (KanCare)·KS·Provider Bulletin
Effective date
Apr 1, 2025
We identified it
Jun 21, 2026
Days to comply
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Summary

Kansas Medicaid will implement MS-DRG Grouper version 42.1 for inpatient claims processing effective April 1, 2025. This updates the diagnosis-related group classifications used to determine reimbursement for hospital inpatient stays under the Kansas Medical Assistance Program (KMAP).

Action Required

Action needed
Before April 1, 2025: Hospital billing teams must verify their claims processing systems are updated to MS-DRG Grouper version 42.1 for Kansas Medicaid inpatient claims. Review the neonatal MS-DRG flowchart and CMS summary of changes to understand new groupings. Monitor the KanCare Open Claims Resolution Log for MCO implementation timelines as these may vary from the April 1 effective date.

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