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EGID Network Management will no longer accept faxed contracts or forms beginning Jan. 1, 2024. All
documents should be sent via email to EGID.NetworkMangament@omes.ok.gov.
In the first quarter of 2024, you will also be able to use our new provider contracting portal. Watch for more details.
If you have questions or need assistance, please email EGID Network Management or call EGID Network
Management at 405-717-8790 or toll-free 844-804-2642.
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The HealthChoice and Department of Corrections annual MS-DRG updates to acute inpatient reimbursement include updates to tier designations based on the number of beds and designated provider type as urban or rural as contained within the current year’s final IPPS file.
MS-DRG
For charges incurred on or after Oct. 1, 2023, the following changes are effective for the HealthChoice and DOC MS-DRG Fee Schedules:
|
Tier
|
1
|
2
|
3
|
4
|
|
Outlier Threshold
|
$198,830.00
|
$153,772.00
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$125,728.00
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$122,479.00
|
|
Marginal Cost Factor
|
0.32
|
0.35
|
0.43
|
0.44
|
|
Base Rate
|
$12,671.00
|
$11,772.00
|
$12,507.00
|
$10,824.00
|
| The market basket update factor is 3.3%. |
The next comprehensive MS-DRG Fee Schedule update will be effective for charges incurred on or after Oct. 1, 2024.
MS-DRG LTCH
For charges incurred on or after Oct. 1, 2023, the following changes are effective for the HealthChoice and DOC MS-DRG LTCH Fee Schedules:
- Version 41 of the MS-DRG LTCH Fee Schedule has a base rate of $61,148.00. The outlier threshold is $59,873.00, while the cost-to-charge ratio is 0.228.
The next comprehensive MS-DRG LTCH Fee Schedule update will be effective for charges incurred on or after Oct. 1, 2024.
If you have any questions regarding these adjustments, call EGID Network Management at 405-717-8790 or toll-free 844-804-2642. TTY users call 711.
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Future fee schedule updates for services by HealthChoice network providers are scheduled for:
|
Annual Fee Schedule Releases
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Jan. 1
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April 1
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July 1
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Oct. 1
|
|
Anesthesia (ASA)
|
Comp
|
|
|
|
|
ASC and ASC Implants
|
A/C/D
|
Comp
|
A/C/D
|
A/C/D
|
|
Bariatric Surgery - Inpatient
|
Comp
|
A/C/D
|
A/C/D
|
A/C/D
|
|
Bariatric Surgery - Outpatient
|
Comp
|
A/C/D
|
A/C/D
|
A/C/D
|
|
Certification Requirements
|
Comp
|
Comp
|
Comp
|
Comp
|
|
CPT
|
A/C/D
|
Comp
|
A/C/D
|
A/C/D
|
|
Dental (ADA)
|
Comp
|
A/C/D
|
A/C/D
|
A/C/D
|
|
Diabetes Prevention Program (DPP)
|
Comp
|
|
|
|
|
Endodontic
|
Comp
|
A/C/D
|
A/C/D
|
A/C/D
|
|
HCPCS
|
A/C/D
|
Comp
|
A/C/D
|
A/C/D
|
|
MS-DRG
|
|
|
|
Comp
|
|
MS-DRG LTCH
|
|
|
|
Comp
|
|
NDC
|
Comp
|
Comp
|
Comp
|
Comp
|
|
Non-CMS Certified Facility
|
Comp
|
Comp
|
Comp
|
Comp
|
|
Outpatient
|
Comp
|
Comp
|
Comp
|
Comp
|
|
Outpatient Revenue
|
Comp
|
A/C/D
|
A/C/D
|
A/C/D
|
|
Preventive Services
|
Comp
|
A/C/D
|
A/C/D
|
A/C/D
|
|
Select Inpatient (MS-DRG)
|
A/C/D
|
A/C/D
|
A/C/D
|
A/C/D
|
|
Select Outpatient/ASC
|
A/C/D
|
A/C/D
|
A/C/D
|
A/C/D
|
| Comp = Comprehensive; A/C/D = Adds, changes, deletes and other necessary updates |
As a reminder, national medical and dental associations may change, add, correct or delete billing codes throughout the year. When that occurs, EGID reviews the modifications as quickly as possible and makes any necessary updates. Additionally, EGID performs fee schedule updates on an ad hoc basis when necessary.
The EGID tiers were created in part to help support the continued existence and financial viability of truly rural hospitals. EGID’s tier designation process is intended to only recognize a rural reimbursement methodology if the urban or rural status is based on the ZIP code of the hospital and the status of that ZIP code in the U.S. Census Bureau’s metropolitan core-based statistical area.
Inpatient and outpatient tier designations and facility urban/rural designations are updated annually on Oct. 1. These designations are determined by the most current Centers for Medicare & Medicaid Services fiscal year inpatient prospective payment system impact file or the facility's ZIP code, included in the U.S. Census Bureau's metropolitan core-based statistical area. On Jan. 1, the urban/rural indicators are updated based on the most recent CMS ZIP code to carrier locality file for all facilities that are not hospitals.
For the most part, the applicable urban tier status is based on the most current CMS fiscal year inpatient prospective payment system impact file for network providers, unless the ZIP code of its physical location is included in the U.S. Census Bureau’s metropolitan core-based statistical area.
Inpatient and outpatient tier designations are defined as:
- Tier 1 – Network urban facilities with greater than 300 beds.
- Tier 2 – All other urban and non-network facilities.
- Tier 3 – Critical access hospitals, sole community hospitals, and Indian, military and VA facilities.
- Tier 4 – All other network rural facilities.
- Tier 6 – Outpatient rural emergency hospitals.
Following each quarterly update of the HealthChoice fee schedule, outpatient rates for the procedures covered under the program will become fully phased in during the next quarterly update.
Fee schedule updates are reported in each quarterly issue of the Network News. If you need specific codes
and allowable fees affected by these updates, please view or download the latest fee schedule addendum.
The fee schedule has not been publicly disclosed and is deemed confidential pursuant to 51 O.S. and should not be disseminated, distributed or copied to persons not authorized to receive the information. If you have
questions or need additional information, please contact EGID Network Management.
For more information, email EGID Network Management or call 405-717-8790 or toll-free 844-804-2642. TTY
users call 711.
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