View the EAPG Expected Reimbursement Detail

Use the following procedure to view the EAPG Expected Reimbursement Detail.

Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.

  1. Access the Expected Reimbursement Detail page for an EAPG account. For more information, refer to View the Expected Reimbursement Details . 
  2. Review the expected reimbursement details.
    • The EAPG Information field displays any error messages.
    • The EAPG Information field displays the EAPG code associated with the claim.
      • Codes beginning with “E” in the EAPG Code column indicate a line item error. Descriptions of the error code display in the EAPG Line Status column.
      • Codes beginning with “9” in the EAPG Code column indicate an EAPG grouper error. The EAPG Information section also indicates that there were EAPG grouper errors when these codes are present.
  3. Optionally, you can perform the following actions:

The following table describes each of the fields on the Expected Reimbursement Detail page for EAPG claims. The fields are listed in alphabetical order.

Field

Description

Charges

Amount billed by the provider

EAPG Code

EAPG code associated with the claim.

  • Codes beginning with “E” in this column indicate a line item error. Descriptions of the error code display in the EAPG Line Status column.
  • Codes beginning with “9” in this column indicate an EAPG grouper error. The EAPG Information section also indicates that there were EAPG grouper errors when these codes are present.

EAPG Type

Displays the EAPG type for each line item.

Note: This column displays for EAPG Oklahoma only.

EAPG Information

Displays any error messages.

EAPG Line Status

Was paid for by EAPG if “EAPG” is present. EAPG codes beginning with “E” indicate a line item error. The error description displays in this column.

EAPG Paid Amount

Amount paid for each EAPG for which there was payment (not all EAPGs on a claim are paid)

EAPG Weight

Factor assigned to each EAPG that is used to calculate the specific payment for that EAPG. Ratio of the relative complexity of the EAPG to the average complexity of all EAPGs

HCPC/CPT Codes

Associated CPT or HCPC codes

Medical EAPG

EAPG code associated with the claim

Medical EAPG Payment

EAPG payment, consisting of the EAPG weight multiplied by the conversion factor. Includes pass-through amounts

Medical EAPG Type

Code which denotes the packaging, bundling, and categorizing for multiple interrelated services into a single type group.

Medical EAPG Weight

Factor assigned to each EAPG that is used to calculate the specific payment for that EAPG. Ratio of the relative complexity of the EAPG to the average complexity of all EAPGs.

No.

Sequential reference number of the line item

Outlier/Inlier
  • Indicator – Outlier or inlier indicator
  • Amount – Outlier or inlier amount associated with the account

Rev Code

Revenue code

Units

Quantity billed per line item