MedicaidDocumentationHigh impact
Provider Letter 2025-02: RE: Pre-Pay Diagnosis Related Group Payments
Oklahoma SoonerCare·OK·Reimbursement
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Aetna Better Health of Oklahoma will implement pre-payment DRG validation starting April 1, 2025, requiring medical records to support all diagnosis and procedure codes submitted on claims. Claims with unsupported DRGs will be reimbursed at the calculated rate or denied based on Oklahoma state regulations.
Action Required
Before April 1, 2025: Billing team must ensure all inpatient claims to Aetna Better Health of Oklahoma include comprehensive documentation in medical records that supports every diagnosis and procedure code submitted. Review current DRG coding practices and establish quality checks to verify medical record documentation matches claim codes. Contact ABHOK at 1-844-365-4385 for questions. Claims with insufficient documentation will be reimbursed at lower calculated DRG rates or denied.