Surprises can be fun, but not when it comes to reimbursement. Our software calculates expected reimbursement using predefined logic and custom rate schedules, with you defining the parameters (e.g., hospital values, statistics files and other reimbursement variables) that will govern payment processing of claims.
The reimbursement schemes in the table below can be licensed in the U.S. for Solventum GPCS. Find options for commercial, TRICARE, Medicare and Medicaid reimbursement. You have the option of licensing the add-on Solventum™ Pricer Tables, which provide facility-specific variables for all applicable hospitals for calculating reimbursement for multiple providers.
Payer
| Inpatient grouper
| Outpatient grouper/editor
|
|---|
| Alabama Blue Cross Blue Shield | | Solventum EAPGs |
| Alaska Medicaid† | Solventum APR DRGs | |
| Arizona Medicaid† | Solventum APR DRGs | |
| California Medicaid | Solventum APR DRGs | CMS APC |
| Colorado Medicaid | Solventum APR DRGs | Solventum EAPGs |
| Connecticut Medicaid | Solventum APR DRGs | |
| District of Columbia Medicaid† | Solventum APR DRGs | Solventum EAPGs |
| Florida Medicaid† | Solventum APR DRGs | Solventum EAPGs |
| Georgia Medicaid† | Solventum APR DRGs | |
| Hawaii Medicaid† | Solventum APR DRGs | |
| Idaho Medicaid† | Solventum APR DRGs | |
| Illinois Medicaid† | Solventum APR DRGs | Solventum EAPGs |
| Indiana Medicaid | Solventum APR DRGs | |
| Maryland | Solventum APR DRGs | Solventum EAPGs |
| Massachusetts Blue Cross Blue Shield | Solventum APR DRGs | |
| Massachusetts Medicaid† | Solventum APR DRGs | Solventum EAPGs |
| Medicare – Ambulatory Surgical Center Prospective Payment System (ASC PPS)† | | Solventum Medicare Ambulatory Surgical Center (based on APC) |
| Medicare – End Stage Renal Disease Prospective Payment System (ESRD PPS)† | | Solventum Medicare Renal Dialysis Facility (MRDF) Editor |
| Medicare – Home Health Prospective Payment System (HH PPS)† | | Patient Driven Groupings Model (PDGM) and predecessor Home Health PPS (HH PPS) grouper |
| Medicare – Hospice Prospective Payment System (Hospice PPS)† | | Medicare Integrated Outpatient Code Editor (IOCE) |
| Medicare – Inpatient Prospective Payment System (IPPS), includes Medicare Advantage† | Medicare Severity Diagnosis Related Groups (MS-DRG) and predecessor CMS DRG | |
| Medicare – Inpatient Psych Facility Prospective Payment System (IPF PPS)† | Solventum Medicare IPF grouper (based on MS-DRG/CMS DRG) | |
| Medicare – Inpatient Rehab Facility Prospective Payment System (IRF PPS)† | Case Mix Grouper (CMG) | |
| Medicare – Long Term Care Hospital Prospective Payment System (LTCH PPS)† | Medicare Severity Diagnosis Related Groups (MS-DRG) and predecessor CMS DRG | |
| Medicare – Outpatient Prospective Payment System (OPPS) with Hospital Outpatient Department (HOPD) and Federally Qualified Health Center Prospective Payment System (FQHC PPS)† | | Medicare Ambulatory Payment Classification (APC) |
| Medicare – Professional Claims† | | Solventum Medicare Professional Claims Editor (PCE) |
| Medicare – Skilled Nursing Facility Prospective Payment System (SNF PPS)† | Patient Driven Payment Model (PDPM) and predecessor Resource Utilization Groups (RUG) | Medicare Integrated Outpatient Code Editor (IOCE) |
| Michigan Medicaid† | Solventum APR DRGs | |
| Minnesota Blue Cross Blue Shield | Solventum APR DRGs | Solventum EAPGs |
| Minnesota Medicaid | Solventum APR DRGs | |
| Mississippi Medicaid† | Solventum APR DRGs | |
| Missouri Medicaid† | Solventum APR DRGs | |
| Montana Medicaid | Solventum APR DRGs | |
| Nebraska Blue Cross Blue Shield | Solventum APR DRGs | Solventum EAPGs |
| Nebraska Medicaid† | Solventum APR DRGs | Solventum EAPGs |
| New Jersey Medicaid† | Solventum APR DRGs | |
| New York Medicaid, Medicaid Managed Care, Workers’ Comp and No-Fault† | Solventum APR DRGs | Solventum EAPGs |
| North Dakota Blue Cross Blue Shield | Solventum APR DRGs | Solventum EAPGs |
| North Dakota Medicaid† | Solventum APR DRGs | Solventum EAPGs |
| Ohio Medicaid† | Solventum APR DRGs | Solventum EAPGs |
| Oklahoma Blue Cross Blue Shield | Solventum APR DRGs | Solventum EAPGs |
| Pennsylvania Medicaid | Solventum APR DRGs | |
| Puerto Rico Medicaid† | Solventum APR DRGs | |
| Rhode Island Medicaid | Solventum APR DRGs | |
| South Carolina Medicaid | Solventum APR DRGs | |
| Texas Medicaid† | Solventum APR DRGs | Solventum EAPGs |
| TRICARE†† | TRICARE DRG | TRICARE APC |
| Virginia Medicaid† | Solventum APR DRGs | Solventum EAPGs |
| Washington Medicaid† | Solventum APR DRGs | Solventum EAPGs |
| Washington Workers’ Comp | Solventum APR DRGs | |
| Wellmark Blue Cross Blue Shield | Solventum APR DRGs | Solventum EAPGs |
| Wisconsin Medicaid† | Solventum APR DRGs | Solventum EAPGs |
| Wyoming Medicaid† | Solventum APR DRGs | |
| N/A - Solventum All Patient Refined (APR) DRG National Weights | Solventum APR DRGs | |
| N/A – Solventum Enhanced Ambulatory Patient Grouping System (EAPGS) National Weights | | Solventum EAPGs |
| N/A – Solventum Inpatient Calculation Toolkit (IPCT) | Solventum APR DRGs, MS-DRG/CMS DRG, TRICARE DRG | |
| N/A – Solventum Outpatient Calculation Toolkit (OPCT) | | Solventum EAPGs |
*Available content is current as of publication, but Solventum is constantly developing new grouping, editing and reimbursement content to meet market needs. Please check with your Solventum representative for the latest updates.
†Pricer Tables available.
††Pricer Tables available for outpatient only.
