Diagnosis-Related Group Dictates Reimbursement for Inpatient Acute Care in Oklahoma for Our Commercial Members 

Oct. 9, 2026

We want to remind providers that reimbursement for inpatient acute care services for commercial members is based on a diagnosis-related group reimbursement methodology. The authorized length of stay is determined based on the clinical information submitted with the initial authorization request.

Once we approve initial medical necessity for the LOS associated with the DRG, you do not need to continue to submit additional clinical information related to the stay. This creates an unnecessary administrative burden for you and your staff.

We will reach out to your facility when we need new clinical information. 

For questions, email us or contact your Provider Relations Representative.