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In-patient Add-On Payments Are Limited to Approved Days of an APR-DRG Reimbursed Stay

Date: 07/13/26

Meridian and YouthCare would like to remind acute care facilities that Medicaid High Volume Adjustments (MHVA), Medicaid Percentage Adjustment (MPA), and Safety Net add-on per diem payments are reimbursable only for approved days of an in-patient stay.

In-patient stays for Meridian and YouthCare are reimbursed through an APR-DRG payment methodology. The All Patient Refined-Diagnosis Related Groups (APR-DRG) APR-DRG payment is a single, predetermined payment that covers the entire in-patient stay from admission through discharge. MHVA, MPA, and Safety Net payments are reimbursed separately as per diem add-on payments in addition to the APR-DRG case payment.

All in-patient stays require prior authorization to determine medical necessity, including the appropriate length of stay. In some cases, not all requested days are approved as medically necessary. The prior authorization will reflect the number of approved days.

If a member remains hospitalized for more days than were approved, the facility is entitled to:

  • The full APR-DRG case payment
  • MHVA, MPA, and Safety Net add-on payments only for the approved days.

Example

  • A stay is requested for seven days
  • The stay is approved for five days
  • Payment will include the full APR-DRG case payment plus five days of MHVA, MPA, and Safety Net add-on payments
  • Because the APR-DRG payment covers the entire in-patient stay, the APR-DRG reimbursement remains the same whether the stay is five approved days or seven actual days
  • However, MHVA, MPA, and Safety Net payments are reimbursed on a per diem basis and are payable only for approved days

To identify claims that include MHVA, MPA, and/or Safety Net add-on payments, claims will be processed with explanation code EX3M – Partial Payment of Facility Add-Ons.

Meridian will review APR-DRG claims to ensure reimbursement of MHVA, MPA, and Safety Net add-on payments are limited to approved days for prospective and retrospective dates of service.

For questions, please contact Meridian Provider Services at 866-606-3700, or YouthCare Provider Services at 844-289-2264.