Solventum™ Grouper Plus Content Services (GPCS)
For many years, third party software vendors, payers, consultants and analytics companies worldwide have embedded Solventum regulatory content within their own applications. This approach gives clients integrated access to this valuable content and allows them to analyze and report on data for their own customers.
To support businesses faced with intense IT resource pressures and time constraints, Solventum can deliver our rich regulatory and proprietary content through web services, industry standard interfaces and a cloud environment. Solventum™ Grouper Plus Content Services (GPCS) leverages web technology to deliver content with greater timeliness and less maintenance than on-premises systems. Solventum GPCS provides up to date, secure access to grouping, reimbursement, editing and pay-for-outcomes classifications. The content can be viewed from many different workflows.
Product details
Available content
Healthcare is a dynamic industry with frequent regulatory changes, and we continuously update our grouping, editing, reimbursement and population health content. Explore the accordions below to discover content application options for Solventum GPCS that enable you to access the necessary data to support value-based care.
These applications contain the necessary tables and logic to accurately classify inpatient and outpatient services. Solventum GPCS can be licensed with a single clinical classification methodology or a combination to meet your needs.
- Centers for Medicare & Medicaid Services (CMS) Diagnosis Related Groups (DRGs) and Medicare-severity Diagnosis Related Groups (MS-DRGs) can classify claims for Medicare patients of acute care hospitals and long-term care hospitals
- Medicare Ambulatory Payment Classifications (APCs) can group items and services provided by hospital outpatient departments for payment under the Hospital Outpatient Prospective Payment System (OPPS)
- Medicare Skilled Nursing Facility (SNF) can classify SNF services under the prospective payment system (PPS)
- Medicare Home Health can classify home health services
- TRICARE DRGs includes additional DRGs not related to the Medicare population for services provided to TRICARE beneficiaries at acute care hospitals or long-term care hospitals
- TRICARE APCs includes additional DRGs not related to the Medicare population for services provided to TRICARE beneficiaries in hospital outpatient departments
- Solventum™ All Patient Refined Diagnosis Related Groups (APR DRGs) Classification System can classify all patient populations treated in the inpatient setting (including sick and healthy newborns, pediatrics and obstetrics) using four levels of severity of illness and risk of mortality
- Solventum™ Enhanced Ambulatory Patient Groups (EAPGs) Classification System can classify all patient populations treated in outpatient care settings (including the emergency department, other hospital outpatient departments, ambulatory surgical centers and other diagnostic and treatment clinics) using visits, not individual services, for analysis
It’s always better to get a second set of eyes to double check data. Our editing applications play that role for patient records, helping to validate appropriate use of ICD-10 codes, present on admission (POA) indicators, medical necessity edits and more.
Inpatient edits:
- CMS Medicare Code Editor (MCE), automatically included with Solventum’s inpatient groupers, helps validate the appropriate use of ICD-10 diagnosis and procedure codes.
- Solventum POA editor, automatically included with Solventum’s inpatient groupers, helps verify that POA indicators are appropriate for the ICD-10 code being reported.
- Solventum solutions for medical necessity edits can be licensed as an add-on to Solventum GPCS to review the validity of Medicare national coverage determinations (NCDs), local coverage determinations (LCDs) and frequency, age and gender restrictions; ICD-10 diagnosis codes and modifiers; and other state Medicaid and payer specific edits.
Outpatient edits:
- Solventum versions of the Medicare APC and TRICARE APC grouper applications automatically include:
- National Correct Coding Initiative (NCCI) edits
- Medically Unlikely Edits (MUEs)
- Medicare/TRICARE Outpatient Code Editor (OCE)
- Robust suite of proprietary edits to identify potential lost revenue, provide clarity to OCE edits and address areas that CMS examines, but which are not addressed in the public domain grouper
- Solventum’s Medicare solutions for ambulatory surgical centers, renal dialysis facilities, professional claims, home health and hospice automatically include:
- NCCI edits
- MUEs
- Robust suite of proprietary edits to ensure correct coding and billing, and identify potential lost revenue
- Solventum EAPG automatically includes:
- NCCI edits
- MUEs
- Suite of edits designed to ensure correct coding and billing, and identify potential lost revenue
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 | |
| Colorado Medicaid | Solventum APR DRGs | Solventum EAPGs |
| Connecticut Medicaid | Solventum APR DRGs | CMS APC |
| 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 | |
| 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 | |
| South Dakota Medicaid† | Solventum APR DRGs | |
| Texas Medicaid† | Solventum APR DRGs | |
| 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.
Data plays a key role in advancing value-based care. Our population health solutions transform medical and claims data into actionable insights that enable payers and healthcare providers to work together to support health quality outcomes while controlling costs.
Our solutions cover different care settings and types of adverse events to hone in on specific issues and opportunities. License them individually with Solventum GPCS or build a bundle based on your needs and focus areas.
Track and trend potentially preventable medical events that may have resulted from the process of care and treatment rather than from the natural progression of an underlying illness for the following situations:
- In-hospital complications — Solventum™ Potentially Preventable Complications (PPCs) Classification System
- Complications following elective ambulatory procedures — Solventum™ Ambulatory Potentially Preventable Complications (AM-PPCs) Classification System
- Hospital or ED readmissions following a hospitalization — Solventum™ Potentially Preventable Returns to the Hospital (PPRH) Classification System
- Hospital admissions — Solventum™ Potentially Preventable Admissions (PPAs) Classification System
- ED visits — Solventum™ Potentially Preventable Emergency Department Visits (PPVs) Classification System
- Ancillary services — Solventum™ Potentially Preventable Services (PPSs) Classification System
- Maternal health, from antepartum to 12 months postpartum — Solventum™ Severe Maternal Morbidity (SMM) Classification System
Align payment incentives with clinical goals and effectively perform chronic disease risk adjustment with Solventum™ Clinical Risk Grouping (CRGs) Classification System. This solution also supports provider profiling, quality measurement and outcomes improvement.
Support value-based care outcomes by defining more than 500 episodes spanning inpatient and outpatient encounters and chronic and acute diseases with Solventum™ Patient-focused Episodes (PFEs) Classification System. This solution also supports provider profiling based on risk-adjusted clinical outcomes and computes actual costs and expected resource utilization.
Promote patient safety by gaining actionable insights for developing a quality improvement program to measure and track clinical performance and outcomes with Solventum™ Grouping Software with AHRQ Quality Indicators. This solution can group the codes and patient information required to process Agency for Healthcare Research and Quality (AHRQ) Quality Indicators™ to help analyze data for quality concerns, and track and trend changes over time.
Manage data, analyze performance and identify areas for improvement related to Healthcare Effectiveness Data and Information Set (HEDIS®) measures.
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