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Medi-CalMedicaid · Administrative · Provider Bulletin · CAHigh impact

Diagnosis Related Group (DRG) Pricing Resources SFY 2026/27

Act
by Jun 30, 2026
Effective date
Jul 1, 2026
Identified
Aug 18, 2026

Summary

California DHCS has updated DRG Grouper Settings for State Fiscal Year 2026/27 (effective July 1, 2026) to reflect Solventum Grouper software updates. Hospitals must import the new SFY 2026/27 DRG Grouper Import File (CSV format) to ensure grouper settings match DHCS standards. Critical requirement: When using Solventum Core Grouping Software for claims with admit dates on or after July 1, 2026, procedure dates must be entered with relevant procedure codes to ensure accurate DRG assignment and reimbursement.

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What to do

by Jun 30, 2026 · 2 steps
01Hospital billing and IT teams must (1) download the SFY 2026/27 DRG Grouper Import File and SFY 2026/27 DRG Grouper Settings documents from the DHCS DRG webpage (Pricing Resources: SFY 2026/27 section); (2) follow the 'Importing Grouper Settings from a CSV File' instructions to import the CSV file into your Solventum Core Grouping Software; (3) verify grouper settings match DHCS standards before July 1, 2026; (4) train billing staff and providers that ALL claims with admit dates on or after July 1, 2026 MUST include procedure dates with corresponding procedure codes during grouping to ensure accurate DRG assignment.
02Update encounter forms and billing workflows to require procedure date entry.
If missed: Failure to import updated settings and provide procedure dates will result in incorrect DRG assignments, claim denials, and reimbursement delays for all hospital inpatient claims effective July 1, 2026.

Original notice

Diagnosis Related Group (DRG) Pricing Resources SFY 2026/27
mcweb.apps.prd.cammis.medi-cal.ca.gov · Always check the source before changing claims.
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