Common use of DRG Clause in Contracts

DRG. ‌ The DRG field (field #72) is a field requested by CMS. Not all MCEs collect DRGs so MassHealth has developed a preferred course of action: 1. An MCE that collects DRGs- should provide DRG values in data submissions. 2. An MCE that does not collect DRGs, should ensure that primary, secondary, and tertiary diagnosis values are as complete and accurate as possible, so that MassHealth may use a DRG grouper if necessary. Accurate procedure codes are also required for DRG assignment. 3. In the future, MassHealth may request that all MCEs provide DRGs.