TriWest Waiting for DRG Updates for Fiscal Year 2008

TriWest Healthcare Alliance is awaiting the final Fiscal Year 2008 Diagnosis Related Groups (DRG) updates from TRICARE Management Activity (TMA). Once we have the correct information, we will provide a summary of the reimbursement changes effective on October 1, 2007 in our E-Newsletter.

Until TriWest receives the new reimbursement rates from TMA, loads them into our claims system, and tests the systems to ensure accurate payment, all DRG and Mental Health per diem claims with discharge dates October 1, 2007, and later will be held for processing. As a result, we expect that all DRG and Mental Health per diem claims will be held from October 1 until the end of October before they can be processed. Please be assured that TriWest will give loading and testing the new reimbursement rates our highest priority upon receipt of the updates from TMA to minimize the inconvenience to the providers.

TMA has posted the TRICARE/CHAMPUS Adjusted Standardized Amounts (ASAs) & DRG Weights Summary and DRG Payment Calculator on its Web site, which can be found at http://www.tricare.mil/drgrates/index.cfm.

Medicare has adopted a Medicare Severity Diagnosis-Related Group (MS-DRG) classification system for FY08, which begins on October 1, 2007. This new system created 745 new severity-adjusted DRGs to replace the 538 that were in place for FY07. TRICARE will not be adopting the MS-DRG for FY08 and will continue to use its current DRGs. TriWest will accept the new DRGs, but will process them under the old DRGs.