Common use of Grouping Methodology Clause in Contracts

Grouping Methodology. When the MCOP uses a grouping methodology to pay inpatient and/or outpatient hospital claims, or ambulatory surgery center (ASC) claims, they are expected to utilize the same grouper software and inpatient only procedure listing (determined by Medicare and 3M) that ODM uses to process fee-for-service claims. 1. For inpatient hospital claims, the MCOP shall use the 3M All-Patient Refined Diagnosis Related Grouper (APR-DRG) and utilize the same version that ODM uses. 2. For outpatient hospital claims and ASC claims, the MCOP shall use the 3M Enhanced Ambulatory Patient Grouping (EAPG) and utilize the same version that ODM uses.

Grouping Methodology. When the MCOP MCP uses a grouping methodology to pay inpatient and/or outpatient hospital claims, or ambulatory surgery center (ASC) claims, they are expected to utilize the same grouper software and inpatient only procedure listing (determined by Medicare and 3M) that ODM uses to process fee-for-service claims. 1. For inpatient hospital claims, the MCOP MCP shall use the 3M All-Patient Refined Diagnosis Related Grouper (APR-DRG) and utilize the same version that ODM uses. 2. For outpatient hospital claims and ASC claims, the MCOP MCP shall use the 3M Enhanced Ambulatory Patient Grouping (EAPG) and utilize the same version that ODM uses.

Grouping Methodology. When the MCOP MCP uses a grouping methodology to pay inpatient and/or outpatient hospital claims, or ambulatory surgery center (ASC) claims, they are expected to utilize the same grouper software and inpatient only procedure listing (determined by Medicare and 3M) version that ODM uses to process fee-for-service claims. 1. For inpatient hospital claims, the MCOP MCP shall use the 3M All-Patient Refined Diagnosis Related Grouper (APR-DRG) and utilize the same version that ODM uses. 2. For outpatient hospital claims and ASC claims, the MCOP MCP shall use the 3M Enhanced Ambulatory Patient Grouping (EAPG) and utilize the same version that ODM uses.

Grouping Methodology. When the MCOP uses a grouping methodology to pay inpatient and/or outpatient hospital claims, or ambulatory surgery center (ASC) claims, they are expected to utilize the same grouper software and inpatient only procedure listing (determined by Medicare and 3M) version that ODM uses to process fee-for-service claims. 1. For inpatient hospital claims, the MCOP shall use the 3M All-Patient Refined Diagnosis Related Grouper (APR-DRG) and utilize the same version that ODM uses. 2. For outpatient hospital claims and ASC claims, the MCOP shall use the 3M Enhanced Ambulatory Patient Grouping (EAPG) and utilize the same version that ODM uses.