DRG and Short Stay Post-Payment Review Processes

Date: 06/02/23

Effective September 1, 2023, Ambetter from Nebraska Total Care will implement a claims DRG and Short Stay post-pay review process that will begin auditing selected inpatient claims and associated medical records to ensure payments are applied in accordance with national correct coding standard rules and medical necessity.

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

If you have questions, please contact Provider Relations.