Provider Central

Effective September 1, 2026, Blue Cross will partner with Optum, an independent company, to conduct a secondary Diagnosis-Related Group (DRG) validation program.

• Optum will review select inpatient claims to validate the accuracy of the assigned DRGs against established coding guidelines and supporting clinical documentation.
• This program will run in addition to current Blue Cross in-house DRG inpatient audits.

What this will mean for your facility: Starting on or after September 1, 2026, your facility may begin receiving medical record requests directly from Optum to support their review. We appreciate your cooperation in fulfilling these requests in a timely manner.

Thank you for your partnership in our efforts to maintain payment integrity and ensure accurate reimbursement for services provided to our members.

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