All Payer EAPG

Use the Wellmark tab to define the Outpatient EAPG reimbursement terms for Wellmark Blue Cross and Blue Shield contracts.

Note: Refer to the contract to determine the options to select and the values to enter.

The following options are available:

• Override Provider Number – Enter the OP Provider # located on the Loading Table.
• Percent Reimbursement – Enter the applicable percentage amount.

Field Descriptions

The following table describes the fields on the Wellmark tab of the All Payer EAPG reimbursement tool.

Field	Description
Override Provider Number	The Wellmark provider number.
Percent Reimbursement	Three digit percentage amount.
Cap line items at lesser of billed charges or payor reimbursement	Provides the option to cap lines items at lesser of billed charges or payor reimbursement.
Do not consume charges	Provides the option not to consume charges. This is used for contract carve outs. Note: Charges are consumed if this check box is not selected.
Do not consume units	Provides the option not to consume units. This is used for contract carve outs. Note: Units are consumed if this check box is not selected.

Use the AL BCBS tab to define the Outpatient EAPG reimbursement terms for Alabama Blue Cross and Blue Shield contracts.

Note: Refer to the contract to determine the options to select and the values to enter.

The following options are available:

• Override Provider Number – Enter the OP Provider # located on the Loading Table.
• Percent Reimbursement – Enter the applicable percentage amount.
• Replace zero payment – Define the percentage of reimbursement for claims calculated at $0.00.

Field Descriptions

The following table describes the fields on the AL BCBS tab of the All Payer EAPG reimbursement tool.

Field	Description
Override Provider Number	The provider number.
Percent Reimbursement	Three digit percentage amount.
Replace zero payment	The percentage of reimbursement for claims calculated at $0.00. The default value is 100% of billed charges. Any value from 0% to 100% is allowed.
Do not consume charges	Provides the option not to consume charges. This is used for contract carve outs. Note: Charges are consumed if this check box is not selected.
Do not consume units	Provides the option not to consume units. This is used for contract carve outs. Note: Units are consumed if this check box is not selected.

Use the NE_BCBS tab to define the Outpatient EAPG reimbursement terms for Nebraska Blue Cross and Blue Shield contracts.

Note: Refer to the contract to determine the options to select and the values to enter.

The following options are available:

• Override Provider Number – Enter the OP Provider # located on the Loading Table.
• Percent Reimbursement – Enter the applicable percentage amount.
• Cap line items at lesser of billed charges or payer reimbursement – Provides the option to cap line items at lessor of billed charges or payor reimbursement.

Field Descriptions

The following table describes the fields on the NE BCBS tab of the All Payer EAPG reimbursement tool.

Field	Description
Override Provider Number	The provider number.
Percent Reimbursement	Three digit percentage amount.
Cap line items at lesser of billed charges or payor reimbursement	Provides the option to cap line items at lessor of billed charges or payor reimbursement.
Do not consume charges	Provides the option not to consume charges. This is used for contract carve outs. Note: Charges are consumed if this check box is not selected.
Do not consume units	Provides the option not to consume units. This is used for contract carve outs. Note: Units are consumed if this check box is not selected.