MedicaidBilling CodesMedium impact
MS-DRG and LTC-DRG updates and inpatient claim reprocessing
Oregon Health Plan·OR · Pediatrics, Critical Care·Provider
Effective date
Oct 1, 2019
We identified it
Aug 19, 2026
Summary
Oregon Health Authority is updating its claims processing system on November 3, 2019 with MS-DRG Version 37 and new Oregon Unique DRGs effective October 1, 2019. Nine DRG codes are being reassigned (DRGs 317-325 changed to DRGs 521-529). All inpatient claims paid between October 1-November 3, 2019 will be automatically reprocessed the weekend of November 15, 2019 with no action required from providers.
Action Required
No immediate action required from billing team. However, be prepared to: (1) Monitor claims paid between October 1-November 3, 2019 for reprocessing adjustments the weekend of November 15, 2019; (2) On remittance advice received after November 15, expect Detail EOB code 8008 (paper) or Adjustment Reason Code 16 (ERA/Portal) for affected claims—these are system-generated adjustments, not billing errors requiring response; (3) Update internal DRG mapping documentation to reflect the nine code changes (317→521, 318→522, 319→523, 320→524, 321→525, 322→526, 323→527, 324→528, 325→529) for claims submitted after November 3, 2019; (4) If questions arise about specific claim adjustments, contact Oregon Provider Services Unit at dmap.providerservices@dhsoha.state.or.us or 800-336-6016.