View the Oklahoma Medicaid Inpatient Expected Reimbursement Detail

Use the following procedure to view the Oklahoma Medicaid Inpatient Acute Expected Reimbursement Detail (IPPS Payment).

Field Descriptions – Oklahoma Medicaid Inpatient Accounts

The following table describes the fields on the Expected Reimbursement Detail page for Oklahoma Medicaid Inpatient Acute claims.

Field	Description
Base Price	Base price is calculated with a different rate value for each cost-related peer group. Peer groups are chosen to minimize cost variation within groups and maximize variation between groups. Peer group classifications are updated each year based on current hospital characteristics and average costs, which impacts the base rate value. The calculation for a DRG payment is as follows: Payment = (DRG Relative Weight) X (Hospital Base Rate) + (Outlier Adjustment).
Covered Charges	The amount of covered charges.
Covered Days	Number of covered days.
CTC Ratio	Facility-specific charge-to-cost ratio.
DRG	Diagnosis Related Group (DRG) methodology. Oklahoma Health Care Authority currently uses Medicare DRG grouper which is updated in October using the Medicare October update.
DRG Amount	Payment consisting of the DRG peer group base rate which is multiplied by the relative weighting factor. Effective July 1, 2015, payment does not exceed billed charges.
DRG Weight	DRG weight factor established by Medicare for each DRG.
Effective Date	Effective date of the current contract rates.
Error Code	Claim level error code and message explains if claims process normally through Oklahoma Medicaid pricing logic or the reason for the failure to process.
NPI	Facility’s ten-digit National Provider Identification (NPI) number required on all claims.
Outlier Amount	Total amount for extraordinarily high cost (cost outlier) for all service dates.
Per Diem Amount	Per diem amount.
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs).
State ID	Two-letter state identifier used by Medicare (for example, OK).
Transfer Amount	The transfer amount.
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.