Contract Modeling Report: Outpatient Detail

The Outpatient Detail report provides line level detail visibility across all outpatient services including patient name, patient number, table name/reimbursement method, CPT code, charged amount, group amount, and expected amount. This report is only available in .csv file format.

Note: If a claim prices with EAPG, the full claim is evaluated for EAPG pricing and includes codes already priced with different pricing methodologies (fee schedule or other service types). This can cause a code to display twice on the Outpatient Detail report, once for the different pricing methodology and a second time with EAPG.

Column Descriptions

Column Name	Description
Scenario	Name of the scenario used in the model.
Model	Name of the model.
Facility	Name of the facility.
Service Type Name	The service category the procedure code qualified for based on the contract definition.
Patient Name	Name of the patient.
Patient Number	Account number for the patient.
Table Name/Reimbursement Method	Name of the lookup table or the reimbursement method used to calculate the reimbursement.
Sequence	Displays the order in which the procedure code within a grouper table qualifies based on multiple procedure rules.
Revenue Code	Revenue code associated with the account.
CPT	The procedure code associated with the line item.
Modifier	The modifier values associated with the line item.
Unit	Number of units of the procedure code.
EAPG	EAPG code associated with the line item.
EAPG Weight	Factor assigned to each EAPG that is used to calculate the specific payment for that EAPG. Ratio of the relative complexity of the EAPG to the average complexity of all EAPGs.
EAPG Pricing Status	Payment action or exclusion at the claim line level, which explains the method of payment calculation.
APC	Ambulatory Payment Classification code associated with the line item.
APC Weight	The Ambulatory Payment Classification (APC) weight applied to the line item.
Payment Status Indicators	APC payment status code for the associated line item.
Charge Amount	Charges associated with the procedure code.
Group Amount	Reimbursement amount associated with the grouper or fee schedule table.
Expected Amount	The expected reimbursement. For APC claims, the Expected Amount displays the following: If sequestration is applied, the post sequestration rate displays in the Expected Amount column. If sequestration is not applied, the expected base rate displays in the Expected Amount column.