View the California Workers’ Compensation (Outpatient) Expected Reimbursement Detail
Use the following procedure to view the California Workers’ Compensation (Outpatient) Expected Reimbursement Detail.
Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.
Procedure
- Access the Expected Reimbursement Detail page for a Worker’s Compensation Outpatient account. For more information, refer to View the Expected Reimbursement Details .
- Review the expected reimbursements.
- Optionally, you can perform the following actions:
- Click Reimbursement to display the View Contract Profile page. For more information, refer to View a Contract Profile.
- Click All OP to display the service types on the View Contract Profile page. For more information, refer to View a Contract Profile.
- Click View in the Calculation Details column. The Calculation Details page opens. For more information, refer to View Expected Reimbursement Calculation Details.
Field Descriptions – CA Workers’ Compensation Outpatient
The following table describes each of the fields on the Expected Reimbursement Detail page for California Workers’ Compensation outpatient claims. The fields are listed in alphabetical order.
|
Field |
Description |
|
APC Codes |
Ambulatory Payment Classification codes |
|
Applied Percentage |
The percentage of Medicare applied |
|
Billed Charges |
Total billed charges for the product during the selected time period |
|
Billed Units |
Number of units billed |
|
Claim Disposition |
Disposition code for claim level |
|
Claim Error |
Error code for the claim level |
|
CPT/HCPC Codes & Modifiers |
Associated CPT or HCPC codes and modifiers |
|
Error Code |
Reason for rejection or return (claim level), if applicable |
|
Fee Schedule Payment |
Total reimbursement from a fee schedule (Lab, DMEPOS, PEN and therapies) |
|
Medicare APC Payment |
APC portion of the amount Medicare would pay |
|
Medicare APC Payment, Excluding Outliers |
APC portion of the amount Medicare would pay, minus outliers |
|
No. |
Sequential reference number of the line item |
|
Outlier Amount |
Total amount for extraordinarily high cost (cost outlier) for that service date |
|
Paid Units |
Quantity paid |
|
Pass-through Payment |
Total reimbursement for certain high-cost items like implants, high cost drugs and biologicals for which the actual or higher cost is passed through to the payor |
|
Reimbursement Type |
Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs) |
|
Revenue Code |
Revenue code |
|
Service Date |
Date the service was rendered |
|
Status Code |
APC payment status code |
|
Total Claim Outlier Amount |
Total amount for extraordinarily high cost (cost outlier) for all service dates |
|
Total Workers’ Comp. Adjusted Payment |
Amount paid under Workers’ Compensation, after all adjustments |
|
Total Workers’ Comp. Payments, Including Outliers |
Amount paid under Workers’ Compensation, after all adjustments |