View the TRICARE (OPPS) Expected Reimbursement Detail

Use the following procedure to view the TRICARE (OPPS) expected reimbursement detail for outpatient accounts when the Outpatient Prospective Payment System (OPPS) logic is applied.

Note: For more information about the TRICARE OP reimbursement terms., refer to TRICARE Outpatient (OP) Tab.

Field Descriptions – TRICARE OPPS Accounts

The following table describes the fields on the Expected Reimbursement Detail page for TRICARE Outpatient claims when the Non-OPPS logic is not applied.

Field	Description
Allowed Units	Number of units allowed by reimbursement logic
APC Codes	Ambulatory Payment Classification codes for the line item
Billed Charges	Amount billed by the provider for the line item
Billed Units	Number of units billed for the line item
Claim Disposition	Current disposition of the claim: 0 - Claim is not denied 1 - One or more edits are present that cause the claim to be denied 2 - One or more edits are present that cause one or more days of a multiple-day claim to be denied, or a single day claim with all lines denied (edit 18, 48, or 902)
CPT/HCPC Codes & Modifiers	Associated CPT or HCPC codes and modifiers
Error Code	Reason for rejection or return (claim level), if applicable
Expected Payment	The calculated reimbursement for the line item, based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Fee Schedule Payment	Total reimbursement from a fee schedule (Lab, DMEPOS, PEN and therapies)
No.	Sequential reference number of the line item
Other Payment	Non-fee schedule payments (percent of charges)
Outlier Amount	Total amount for extraordinarily high cost (cost outlier) for that service date for the line item
Pass-Through Payment	Total reimbursement for certain high-cost items like implants, high cost drugs and biologicals for which the actual or higher cost is passed through to the payor.
Percent Payment	Displays the percentage of payment for multiple surgeries.
Reason Code	Reason a specific line item was denied or description of how it was paid
Reimbursement	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
Rev Code	Revenue code
Service Date	Date the service was rendered
Status Code	Payment status code: S – Significant procedure not subject to multiple procedure discounting T – Significant procedure subject to multiple procedure discounting
Total APC Payment	APC portion of the amount TRICARE would pay, minus outliers
Total Claim Outlier Payment	Total payment for extraordinarily high cost (cost outlier) for all service dates
Total Payment	Total payment from TRICARE
Total Payment by APC	Payment by APC for the line item
TTPA Amount	Temporary Transitional Payment Adjustment amount
TTPA Payment	Total Temporary Transitional Payment Adjustment payment
TTPA%	The Temporary Transitional Payment Adjustment percentage used to calculate reimbursement