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Important Update: DRG Audit Appeal Timeline Changes
Act
by Oct 31, 2026
Effective date
Nov 1, 2026
Identified
Sep 29, 2026
Summary
BlueCross BlueShield of South Carolina is shortening the DRG audit appeal timeline from 6 months to 90 calendar days, effective November 1, 2026. Providers will now have a total of 120 calendar days from the original review date to respond and appeal (30-day initial response period + 90-day appeal period), down from approximately 210 days previously.
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What to do
by Oct 31, 2026 · 4 steps
01Billing and appeals team must update internal tracking systems and appeal workflows to enforce the new 90-day appeal deadline (measured from the follow-up letter date).
02Implement calendar reminders to flag DRG downgrade appeals that must be submitted within 90 days to avoid forfeiture of appeal rights.
03Train all staff handling DRG appeals on the compressed timeline.
04Update appeal submission procedures and internal documentation to clearly distinguish the 30-day initial response period from the 90-day appeal period.
If missed: Failure to submit appeals within the 90-day window will result in loss of appeal rights and finalization of downgraded DRG determinations.
Original notice
Important Update: DRG Audit Appeal Timeline Changes
southcarolinablues.com · Always check the source before changing claims.