View the Illinois Medicaid IP Expected Reimbursement Detail
Use the following procedure to view the Illinois Medicaid Expected Reimbursement Detail.
Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.
Procedure
- Access the Expected Reimbursement Detail page for an Illinois Medicaid IP 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 the Service Type name 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 – Illinois Medicaid IP Accounts
The following table describes the fields on the Expected Reimbursement Detail page for Illinois Medicaid IP claims.
|
Field |
Description |
|
Capital Amount |
Reimbursement for Capital (equipment and facility) costs |
|
Covered Charges |
Amount of charges covered by Medicare, Workers’ Compensation or TRICARE |
|
Covered Days |
Number of covered days |
|
DRG |
Diagnosis Related Group. If the DRG was submitted with a Severity of Illness code, it displays as DRG-Severity Code, for example, 001-2. |
|
DRG Amount |
Payment consisting of the DRG weight multiplied by the conversion factor. Includes pass-through amounts |
|
DRG Weight |
DRG weight factor established by Medicare for each DRG |
|
DSH Amount |
Disproportionate Share Hospital capital costs |
|
Error Code |
Reason for rejection or return, if applicable |
|
MHVA Amount |
Medicaid High Volume Adjustment |
|
MPA Amount |
Medicaid Percentage Adjustment |
|
Outlier Amount |
Total amount for extraordinarily high cost (cost outlier) |
|
Per Diem Amount |
Per diem payment |
|
Reimbursement Type |
Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs) |
|
Total Reimbursement |
The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data |