View the Wisconsin Medicaid OP Expected Reimbursement Detail (EAPG)

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

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

Field Descriptions – Wisconsin Medicaid OP Accounts (EAPG)

The following table describes the fields on the Expected Reimbursement Detail page for Wisconsin Medicaid OP claims using EAPG.

Field	Description
NPI	Facility’s ten-digit National Provider Identification (NPI) number required on all claims.
Effective Date	Effective date of the current contract rates.
Grouper Version	The EAPG grouper version used for this contract profile.
Grouper Type	The type of DRG grouper used for this contract profile: EAPG.
Base Rate	The base rate for the facility.
EAPG Payment	Expected reimbursement based on EAPG calculations.
Access Payment	Facility specific access payment applied to claim.
Alternate Payment	Payment based on fee schedule.
Total Expected Payment	Total expected payment for claim based on sum of EAPG Payment, Access Payment, and Alternate Payment.
Error Code	The claim-level error or message code.
Error Code Description	Description of the error code at claim level.
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
Service Date	The date of service for each line item.
Revenue Code	The revenue code for each line item on the claim.
HCPC/CPT Code & Modifier	The associated CPT or HCPC code, and modifier for each line item on the claim.
Billed Units	The number of units billed for each line item.
Billed Charges	Total amount billed by the provider for each line item.
Final EAPG	EAPG code assigned by the grouper for the line item.
EAPG Weight	The weight assigned to each EAPG by the grouper.
Total Payment	The expected payment. It is calculated by multiplying the EAPG Weight by the EAPG Base rate defined for the service type.
Final EAPG Type	EAPG type associated with the grouper assigned EAPG.
Payment Percent	Percent of the calculated payment allowed.
Pricing Status	Indication of payment calculation.
Edit Code	The code for Procedure, Revenue Code, or Relationship edits for not processing claim line.