Important Update: DRG Audit Appeal Timeline Changes

Sep. 28, 2026

BlueCross BlueShield of South Carolina's Payment Integrity department will be implementing changes to the Diagnosis-Related Group (DRG) Audit appeal timeline effective on and after Nov. 1, 2026.

What To Expect

When a coding review determines that a DRG downgrade is warranted, providers will have 90 calendar days from the date of the follow-up letter to submit an appeal.

This updated 90-day appeal period replaces the current 6-month appeal timeframe.

Please note that the initial 30-day response period following the original review will remain unchanged. As a result, providers will continue to have a total of 120 calendar days from the date of the original review to respond and appeal.

Questions?

We appreciate your continued partnership and commitment to providing quality care to our members. If you have questions regarding this change, please contact your Provider Relations Consultant.