View the Massachusetts Medicaid OP Expected Reimbursement Detail (EAPG)

Use the following procedure to view the Massachusetts Medicaid Expected Reimbursement Detail for outpatient accounts using EAPG.

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

Field Descriptions – Massachusetts Medicaid OP Accounts (EAPG)

The following table describes the fields on this page.

Field	Description
APEC Outlier	Adjudicated Payment per Episode of Care (APEC) outlier payment.
ATP Payment	Total payment for all lab panel tests not individually reimbursed.
Base Rate	Facility-specific base rate assigned by Payor.
Billed Units	The number of units billed for this line item on the claim.
Charges	The line item total charges billed by the facility, as listed on the claim.
EAPG Payment	Total payment for all line items calculated using EAPG reimbursement methodology.
EAPG Weight	The payor-assigned weight for the grouper-assigned EAPG.
Edit Code	Any edit or error code impacting the reimbursement calculation.
Effective Date	Effective date of the pricing file used for calculating estimated reimbursement.
Error Code	Code indicating reason reprice failed.
Expected Payment	Total expected reimbursement for the line item.
Final EAPG	EAPG code assigned by the Grouper for the line item.
Final EAPG Type	EAPG type associated with the grouper-assigned EAPG.
Grouper Type	Type of Grouper used to calculate estimated reimbursement.
Grouper Version	EAPG Grouper Version used to calculate reimbursement.
HCPCS/CPT Code & Modifier	Line item specific HCPCS or CPT code (and any modifiers) for the service provided, as listed on the claim.
NPI	Facility's 10-digit National Provider Identification number required on all claims.
Other Payment	Total payment for line items calculated by fee schedule or other method not included in other totals.
Payment Percent	Percentage of allowed charge(s) for the line item included in the Expected Reimbursement amount.
Pricing Status	Indicator of how the line item was reimbursed (Full Payment / EAPG, ATP Eligible, Alt. / Other Payment, etc.).
Reimbursement Type	Reimbursement type, either Expected Reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs).
Revenue Code	The 4-digit Revenue Code associated with the line item, as provided on the claim.
Service Date	Line item specific date of service.
Total Expected Payment	Total expected reimbursement amounts for the account, including any contractual adjustments and outliers.