2014 APG Updates/Policy Changes

July 2014

  • Error in the July 1, 2014 APG grouper/pricer

An error in the July APG grouper/pricer release has resulted in overpayment of a small number of Article 28 hospital and free-standing clinic APG claims. The overpayments occurred for claims processed on or after June 26, 2014 (Cycles 1924 and 1925). The Department has voided the affected claims and then reprocessed those same claims in Cycle 1928 (check date 8/4/2014) through the amended grouper/pricer. In addition, there will be a second resubmission of claims in the next week or two involving all APG claims with a date of service on or after 7/1/2014 that were originally processed prior to the release of the revised APG grouper/pricer. Providers do not need to take any additional action to correct the claims in question. Please note that the APG grouper/pricer was released on July 24th with the necessary revisions. Providers should update their desktop Grouper Pricer Software (released July 14, 2014) if they have not already done so. Questions may be directed to the Division of Program Development and Management, Office of Health Insurance Programs, at (518) 473-2160.