Claims DRG: Pre-Payment Processing

Date: 12/07/23

Beginning in January 2024, Ambetter from Nebraska Total Care will implement a claims pre-pay review process that will begin auditing selected inpatient DRG claims and associated medical records to ensure payments are applied in accordance with national correct coding standard rules.

Ambetter from Nebraska Total Care has contracted with Cotiviti to assist us in this effort. If you have claims selected for pre-pay audit, you will receive a letter from Cotiviti requesting medical records for these claim audits on behalf of Ambetter from Nebraska Total Care.