View the Arizona Medicaid OP Expected Reimbursement Detail

Use the following procedure to view the Arizona Medicaid Expected Reimbursement Detail.

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

Field Descriptions – Arizona Medicaid OP Accounts

The following table describes the fields on the Expected Reimbursement Detail page for Arizona Medicaid Outpatient claims.

Field	Description
Error Code	Reason for rejection or return, if applicable.
Provider Number/NPI	Provider’s tax ID number or ten-digit National Provider Identification (NPI) number required on all claims.
Effective Date	Effective date of the current contract rates.
CTC Ratio	Facility-specific charge-to-cost ratio.
Differential Adjustment Payment	Displays the Differential Adjustment Payment (DAP) for the account.
Peer Group Multiplier	Displays the Peer Group Multiplier for the account.
Trauma Center	Displays Yes or No indicating whether or not the facility is a trauma center.
Freestanding Emergency Room	Displays Yes or No indicating whether or not the facility is a freestanding Emergency room.
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs).
Service Date	Date the service was rendered.
Rev Code	Revenue code.
CPT/HCPC Codes & Modifiers	Associated CPT or HCPC codes and modifiers.
Billed Units	Number of units billed.
Paid Units	Number of units paid.
Billed Charges	The total charges incurred for the claim or set of claims that have been repriced.
Cost of Charge	Calculated payment based on Cost to charge (CTC) methodology.
Fee Schedule Rate	Reimbursement from published Fee schedule.
Total Expected Reimbursement	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data. Including the applicable Differential Adjustment Payment (DAP) and Peer Group add on amounts.
Reason Code	Reason for rejection or return, if applicable.