View the ChampVA Expected Reimbursement Detail

Use the following procedure to view the ChampVA reimbursement details for outpatient procedures.

Note: For more information about the ChampVA reimbursement terms, refer to the following:

The following table describes the fields on the Expected Reimbursement Detail page for ChampVA outpatient procedures. For internal users only, the source information is given for some fields, in the format: “Table.Field.”

Field	Description
Error Code	Reason for rejection or return (claim level), if applicable Source: BILLMCAD.ERRCODE
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
MSA Payment	Metropolitan Statistical Area (MSA) payment for grouped surgical procedures
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. NOTE: This field will be blank for true TRICARE.
Fee Schedule Payment	Total reimbursement from a fee schedule (Lab, DMEPOS, PEN and therapies)
Other Payment	Non-fee schedule payments (percent of charges)
Total Expected Reimbursement	Total expected reimbursement on the claim
No.	The sequential reference number for the line item.
Service Date	The date the service was rendered for the line item. Source: UB-92, FL45; UB-04, FL45
Revenue Code	The revenue code for the line item. Source: UB-92, FL42; UB-04, FL42
CPT/HCPC Codes & Modifiers	The associated CPT or HCPC codes and modifiers for the line item. Source: UB-92, FL44; UB-04, FL44
Code Type	Type of code: S – Surgical Code I – Injectable Code C – CMAC Code T – Transplant Donor
Billed Units	The number of units billed for the line item. Source: UB-92, FL46; UB-04, FL46
Billed Charges	The amount billed by the provider for the line item.
Allowed Units	The number of units allowed for the line item.
Rate	The fee schedule rate for the line item.
Expected Payment	The calculated reimbursement for the line item. This value is based on the predefined contract terms and conditions and service type definitions in the system, and the repriced claims data. Source: Billmast.EXPPAY
Reason Code	The reason the line item was denied or description of how it was paid.

Field Descriptions – CHAMPVA Acute

The following table describes the fields on the Expected Reimbursement Detail page for ChampVA Acute procedures. ChampVA Acute follows TRICARE DRG reimbursement.

Field	Description
Error Code	Reason for rejection or return (claim level), if applicable
Reimb.	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
DRG	Diagnosis Related Group code.
DRG Weight	DRG weight factor established by Medicare for each DRG.
Cov Days	Number of covered days.
Cov Charges	The amount of covered charges.
Billed Charges	The amount billed by the provider for the line item.
DRG Inlier Payment	Base payment for all TRICARE claims.
Short Stay Outlier Payment	Payment amount if stay is equal to or less than the Low Day Trim.
Outlier Payment	Total amount paid for extraordinarily high cost, in addition to the DRG payment.
Transfer Payment	Payment amount if UB has a transfer discharge status; in place of DRG Inlier payment.
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.
Blood Clotting Payment	Payment amount if claim includes relevant codes.
Total Expected Reimbursement	Total expected reimbursement on the claim.

Field Descriptions – ChampVA Inpatient Reimbursement (SCH)

The following table describes the fields on the Expected Reimbursement Detail page for ChampVA Inpatient (SCH) procedures. SCH reimburses based on the greater of TRICARE DRG reimbursement amount or Billed Charges * Facility IP Cost-to-Charge Ratio (Facility Costs.

Field	Description
Error Code	Reason for rejection or return (claim level), if applicable.
Reimb.	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
DRG	Diagnosis Related Group code.
DRG Weight	DRG weight factor established by Medicare for each DRG.
Cov Days	Number of covered days.
Cov Charges	The amount of covered charges.
Billed Charges	The amount billed by the provider for the line item.
Adjusted SCH CCR	Displays the adjusted Sole Community Hospitals (SCH) Continuity of Care Record (CCR) factor.
CCR Payment	Displays only if the CCR payment calculation is greater than the APR-DRG
DRG Inlier Payment	Base payment for all TRICARE claims.
Short Stay Outlier Payment	Payment amount if stay is equal to or less than the Low Day Trim.
Outlier Payment	Total amount paid for extraordinarily high cost, in addition to the DRG payment.
Transfer Payment	Payment amount if UB has a transfer discharge status; in place of DRG Inlier payment.
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.
Blood Clotting Payment	Payment amount if claim includes relevant codes.
Total Expected Reimbursement	Total expected reimbursement on the claim.
New Tech Add On	Displays the New Tech add on amount.
Operating VBP Adjustment	Displays the operating value base purchasing adjustment.
New Tech VBP Adjustment	Displays the New Tech value base purchasing adjustment.
Covid19 Adjusted	Indicates Yes or No if adjusted for COVID-19.

Field Descriptions – ChampVA Inpatient Critical Access Hospital (CAH) Reimbursement

The following table describes the fields on the Expected Reimbursement Detail page for ChampVA Inpatient Critical Access Hospital (CAH) procedures. CAH reimburses based on (Billed Charges * Facility Medicare CCR) + Any Pass-through payment amounts.

Field	Description
Reimb.	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
Cov Days	Number of covered days.
Cov Charges	The amount of covered charges.
Billed Charges	The amount billed by the provider for the line item.
CCR	Displays either the facility specific Medicare CCR or the statewide average CCR (if no facility specific is present).
Total Expected Reimbursement	Total expected reimbursement on the claim.

Field Descriptions - ChampVA Inpatient Rehab Reimbursement

The following table describes the fields on the Expected Reimbursement Detail page for ChampVA Inpatient Rehab services. Inpatient Rehab reimburses based on ChampVA CTC.

Field	Description
Reimb.	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
Cov Days	Number of covered days.
Billed Charges	The amount billed by the provider for the line item.
Total Expected Reimbursement	Total expected reimbursement on the claim.

Field Descriptions - ChampVA Sole Community Hospital Inpatient Psychiatric Reimbursementt

The following table describes the fields on the Expected Reimbursement Detail page for ChampVA Sole Community Hospital Inpatient Psychiatric services. Sole Community Hospital Inpatient Psych reimburses based on ChampVA CTC.

Field	Description
Reimb.	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
Billed Charges	The amount billed by the provider for the line item.
Cov Days	Number of covered days.
Cost-to-Charge Ration	The ratio for determining hospital cost based on charges
Total Expected Reimbursement	Total expected reimbursement on the claim.