Field Descriptions
Note: The following table describes the fields on the IN tab of the Medicaid - Facility reimbursement tool.
|
Field |
Description |
|
Override Provider Number |
Preferred provider number. Up to ten alphanumeric digits. Enter the NPI number in this field if either the Use APR-DRG or Use EAPG check boxes are selected. |
|
Override Service Date |
Preferred service date. Use MM/DD/YYYY format. Overrides the service date on the claim with the date you enter. You may use the anchor date instead of this option. |
|
State Code |
This field defaults to IN, and it cannot be changed. |
|
Do not consume charges |
Provides the option not to consume charges. This is used for contract carve outs. |
|
Do not consume units |
Provides the option not to consume units. This is used for contract carve outs. |
|
HAF Facility |
Hospital Assessment Fee |
|
Apply 72 hour Obsv Cap |
When this check box is selected (checked/active), only the Wfirst 72 hours—or the first three service lines—of Observation Revenue Code 762 return an expected reimbursement. Any observation service lines beyond the initial 72 hours—or more than three service lines— return an expected reimbursement of $0.00, along with a reason code 89U (Line exceeds 72-hour limit restriction for observation). Note: This check box defaults to unchecked/inactive. A case is required to activate this option in the node (reimbursement tool). |