Medicaid Fiscal Year 2025-26 Diagnosis-Related Groups. Enhanced Ambulatory Patient Groups Solventum Grouper Version
- Ask Medicaid Florida
- Aug 2, 2025
- 3 min read
Updated: Nov 9, 2025
Florida Medicaid Health Care Alert July 29, 2025. Provider Type(s): 01, 06, 70. State Fiscal Year 2025-26 Diagnosis-Related Groups and Enhanced Ambulatory Patient Groups Solventum Grouper Version Update.
The Agency for Health Care Administration has implemented Solventum grouper version 2025.2.2 for Diagnosis-related Groups (DRG) and Enhanced Ambulatory Patient Groups (EAPG) inpatient and outpatient hospital services. The purpose of these updates was to install the latest grouper version available.
To receive the higher rate for fee-for-service (FFS) claims or encounters with discharge date on or after July 1, 2025, and submitted between July 1, 2025, and July 23, 2025, you will need to submit an adjustment. If the Billed Amount is less than the new rate, the Billed Amount(s) must be updated. Florida Medicaid pays the lesser of the amount billed or the allowed amount. Detailed instructions are below for FFS claim and encounter transaction adjustments.
The various Fee Schedules can be accessed on the Agency’s website at the link below:
Below are the instructions for submitting FFS claim and encounter transaction adjustments:
To Submit FFS adjustments via secure Web Portal (Date of Service must be no older than 12 months prior to the current date):
Open the claim, make necessary changes (including Billed Amount(s)), then click the Adjust button. If there are no changes to make, then just click the Adjust button.
For additional information on submitting claims via the secure Web Portal, please refer to the Direct Data Entry (DDE) Claim Form Presentations on the public Web Portal.
Submit Adjustment (FFS or encounter) via X12 837 transaction:
Adjusted claims must contain a frequency code of “7” and the 13-digit ICN of the paid claim being adjusted in the REF02 segment of the X12 837 transaction.
For additional information on the successful processing of adjustments, please refer to the EDI companion guides on the public Web Portal.
For additional information on DRG and EAPG, please visit the Medicaid hospital and ambulatory surgical center website at Hospital Rates/Ambulatory Surgical Centers | Florida Agency for Health Care Administration.
QUESTIONS? FLMedicaidManagedCare@ahca.myflorida.com COMPLAINTS OR ISSUES? ON LINE ahca.myflorida.com/Medicaid/complaints/ | CALL 1-877-254-1055 |
Conclusion
The Agency for Health Care Administration has adopted Solventum Grouper version 2025.2.2 for Diagnosis-Related Groups (DRG) and Enhanced Ambulatory Patient Groups (EAPG) used in inpatient and outpatient hospital services. This update ensures the use of the most current grouper version available.
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