Medicare AdvantageReimbursementMedium impact
OfficeLink Updates - November 2025 notices and reminders - edition 11/6/25 (PDF)
Aetna·Emergency Medicine, Critical Care·Newsletter
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Aetna has delayed implementation of their Level of Severity Inpatient Payment Policy from November 15, 2025 to January 1, 2026. The policy will only apply severity reviews to urgent/emergent inpatient stays of 1-4 midnights for Medicare and SNP members, while stays of 5+ midnights will automatically be paid at the inpatient DRG rate.
Action Required
Before January 1, 2026: Billing team must update inpatient claim processing workflows for Medicare and SNP members. Configure systems to flag urgent/emergent stays of 1-4 midnights for potential severity review requirements. Ensure stays of 5+ midnights are processed for standard inpatient DRG payment. Train staff on new severity review request process through Aetna medical directors for short stays not meeting MCG criteria.