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Indiana Medicaid (IHCP)Medicaid · Reimbursement · Claims & Billing · INMedium impact

BT2025144: Claims impacted by APR-DRG V42 grouper upgrade and inpatient hospital reimbursement rates

Effective date
Aug 1, 2025
Identified
Jun 18, 2026

Summary

The Indiana Health Coverage Programs (IHCP) upgraded to APR-DRG version 42 for inpatient hospital stays with discharge dates on/after August 1, 2025, implemented retroactively on October 1, 2025. Previously submitted claims will be automatically mass adjusted or reprocessed, with adjusted claims appearing on remittance advices starting November 20, 2025.

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What to do

Action · 3 steps
01Starting November 20, 2025: Billing teams should monitor remittance advices for automatically adjusted inpatient hospital claims with ICNs/Claim IDs beginning with '52' (mass replacements non-check related).
02No manual resubmission required as claims will be automatically reprocessed.
03Contact Gainwell Technologies at 800-457-4584 with questions about adjusted reimbursements.

Original notice

BT2025144: Claims impacted by APR-DRG V42 grouper upgrade and inpatient hospital reimbursement rates
in.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Indiana Medicaid (IHCP) changes →
BT202059: IHCP announces changes to DRG grouperHighEffective Aug 1, 2020 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list

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