MedicaidReimbursementMedium impact
BT2025144: Claims impacted by APR-DRG V42 grouper upgrade and inpatient hospital reimbursement rates
Indiana Medicaid (IHCP)·IN·Claims & Billing
Effective date
Aug 1, 2025
We identified it
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.
Action Required
Starting 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). No manual resubmission required as claims will be automatically reprocessed. Contact Gainwell Technologies at 800-457-4584 with questions about adjusted reimbursements.