Inpatient Readmission Reimbursement Implementation Update

On July 1, 2020 you received our message advising of Optima Health’s implementation plan for the recent Department of Medical Assistance Services (DMAS) mandated reimbursement changes applicable to inpatient readmission, emergency room facility, and emergency room physician claims effective July 1, 2020.

Due to unexpected delays, our system updates for the emergency room facility and emergency room physician claims were completed on August 4 and August 25, 2020, respectively. Appropriately billed claims submitted prior to this date will be reprocessed.

Please contact your Optima Health contract manager if you have any questions related to these changes.