View the New York Medicaid OP Expected Reimbursement Detail for Office of Mental Health (OMH)

Use the following procedure to view the New York Medicaid Expected Reimbursement Detail for outpatient accounts for Office of Mental Health (OMH).

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

  1. Access the Expected Reimbursement Detail page for a New York Medicaid OP account. For more information, refer to View the Expected Reimbursement Details .
  2. Review the expected reimbursements.
  3. Optionally, you can perform the following actions:

The following table describes the fields on the Expected Reimbursement Detail page for New York Medicaid OP claims for OMH.

Field

Description

Action/Error Code

A code that denotes the payment action or exclusion at the claim line level, which explains the method of payment calculation.

Billed HCPC/CPT Code

Associated HCPC or CPT code.

Billed Units

Number of units billed.

Covered Charges

Amount of charges covered by Medicaid.

Effective Date

Effective Date.

Error Code

The reason for rejecting or returning the claim, if applicable.

OHM 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.

Paid Units

The number of unites paid for each line item.

Provider Number

Provider Number.

Rate Amount

The rate amount for the claim.

Rate Code

Facility’s location of service associated with a specific base rate.

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.

State ID

The two-letter state identifier.