Aug. 13, 2026

Effective Nov. 15, 2026, we will begin reviewing claims billed with inpatient short-stay admissions for medical necessity. You may receive requests for medical records to validate inpatient status and billing during the review.

Consistent with the manual para proveedores and/or provider agreement, we’ll issue refund requests or recoup from future payments if overpayments are identified. As a reminder, you may not balance bill members for any funds owed in these overpayments.

You can submit an Apelaciones if you disagree with the decision.

If you have questions, contact Provider Customer Service at .