View the Outpatient EAPG Reimbursement Detail

Use the following procedure to view the Outpatient EAPG Reimbursement Detail.

Note: The EAPG grouper version and base rates are defined using the All Payer EAPG term reimbursement editor.

  1. Access the Expected Reimbursement Detail page for an Outpatient EAPG 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 each of the fields on the Expected Reimbursement Detail page for EAPG outpatients.

Field

Description

Error Code

The claim-level error or message code.

Reimbursement Type

The reimbursement type, either expected reimbursement or RA, for each line item (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 and 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.

Charges

Total amount billed by the provider for each line item.

Final EAPG

The EAPG that the CPT code on each the line was grouped to.

EAPG Weight

The weight assigned to each EAPG by the grouper.

Expected Payment

The expected payment. It is calculated by multiplying the EAPG Weight by the EAPG Base rate defined for the service type.

Edit Code

The code for Procedure, Revenue Code, or Relationship edits for not processing claim line.

Edit Code Description

Description of the code for Procedure, Revenue Code, or Relationship edits for not processing claim line.