View the Florida Medicaid IP Expected Reimbursement Detail (APR-DRG)

Use the following procedure to view the Florida Medicaid Expected Reimbursement Detail for inpatient accounts using APR-DRG.

Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.

Field Descriptions (prior to 07/01/2022)

The following table describes the fields on the Expected Reimbursement Detail page for Florida Medicaid inpatient accounts using APR-DRG prior to 07/01/2022. The fields are listed in alphabetical order. For internal users only, the source information is given for some fields, in the format: “Table.Field.”

Field	Description
Auto IGT Payment	The automatic Intergovernmental Transfer (IGT) payment amount added on to the claim. This amount is listed twice on the Florida Medicaid Expected Reimbursement Detail: The first amount is the flat amount specific to that hospital. The second amount is the expected IGT payment amount added on to the claim.
Cost Outlier Payment	A cost outlier occurs if a hospital's charges exceed a specified amount above the statewide average price.
Covered Charges	The amount of covered charges
Covered Days	Number of covered days
CTC Ratio	Facility-specific charge-to-cost ratio
DRG	Diagnosis Related Group code. If the DRG was submitted with a Severity of Illness code, it displays as DRG-Severity Code, for example, 001-2.
DRG Base Rate	The base rate for the specified DRG
DRG Payment	Payment consisting of the DRG weight multiplied by the conversion factor. Includes pass-through amounts
DRG Weight	DRG weight factor established by Medicare for each DRG
Effective Date	Effective date of the current contract rates Source: Billmast.CONEFFDATE
Error Code	Reason for rejection or return, if applicable BILLMCAD.ERRCODE
Grouper Type	The type of DRG grouper used for this contract profile: AP-DRG APR-DRG MS-DRG ICD-10 MS-DRG TRI-DRG
Grouper Version	The DRG grouper version used for this contract profile.
Hac Version	Indicates which Hospital Acquired Condition (HAC) version is used for this contract profile. This option is only available for contracts using APR-DRG Grouper version APR26 or later. This field is automatically populated based on the DRG Grouper Version selected. Note: For versions prior to APR26, the HAC Version value is blank.
HAC Adjusted DRG	The Hospital Acquired Conditions (HAC) adjusted DRG.
Non-covered Charges	The amount of non-covered charges (not disallowed charges)
NPI	The ten-digit National Provider Identification (NPI) number required on all claims. Source: UB-92, FL51; UB-04, FL51 PROVNUM
Provider Number	The provider’s tax ID number
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
Self Funded IGT Payment	The self-funded Intergovernmental Transfer (IGT) payment amount added on to the claim. This amount is listed twice on the Florida Medicaid Expected Reimbursement Detail: The first amount is the flat amount specific to that hospital. The second amount is the expected IGT payment amount added on to the claim.
State ID	Two-letter state identifier used by Medicare (e.g., FL)
Total Expected Reimbursement	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Transfer Payment	Payment amount if UB has a transfer discharge status; in place of DRG Inlier payment

Field Descriptions (effective 07/01/2022)

The following table describes the fields on the Expected Reimbursement Detail page for Florida Medicaid inpatient accounts using APR-DRG effective 07/01/2022. The fields are listed in alphabetical order. For internal users only, the source information is given for some fields, in the format: “Table.Field.”

Field	Description
Childerns Hospital Add-on Average Amount	The average Add-on amount to be paid per inpatient stay for qualified Childrens Hospital accounts.
Childerns Hospital Add-on Casemix Adjustor	Multiplier used to calculate account-specific Childrens Hospital Add-on Payment. Calculated as the DRG weight/facility-specific DRG Casemix.
Childerns Hospital Add-on Payment	The calculated total Childrens Hospital add-on amount to be added to the total DRG Payment.
Cost Outlier Payment	A cost outlier occurs if a hospital's charges exceed a specified amount above the statewide average price.
Covered Charges	The amount of covered charges
Covered Days	Number of covered days
CTC Ratio	Facility-specific charge-to-cost ratio
DRG	Diagnosis Related Group code. If the DRG was submitted with a Severity of Illness code, it displays as DRG-Severity Code, for example, 001-2.
DRG Base Rate	The base rate for the specified DRG
DRG Payment	Payment consisting of the DRG weight multiplied by the conversion factor. Includes pass-through amounts
DRG Weight	DRG weight factor established by Medicare for each DRG
Effective Date	Effective date of the current contract rates Source: Billmast.CONEFFDATE
Error Code	Reason for rejection or return, if applicable BILLMCAD.ERRCODE
Grouper Type	The type of DRG grouper used for this contract profile: AP-DRG APR-DRG MS-DRG ICD-10 MS-DRG TRI-DRG
Grouper Version	The DRG grouper version used for this contract profile.
Hac Version	Indicates which Hospital Acquired Condition (HAC) version is used for this contract profile. This option is only available for contracts using APR-DRG Grouper version APR26 or later. This field is automatically populated based on the DRG Grouper Version selected. Note: For versions prior to APR26, the HAC Version value is blank.
HAC Adjusted DRG	The Hospital Acquired Conditions (HAC) adjusted DRG.
Non-covered Charges	The amount of non-covered charges (not disallowed charges)
NPI	The ten-digit National Provider Identification (NPI) number required on all claims. Source: UB-92, FL51; UB-04, FL51 PROVNUM
Provider Number	The provider’s tax ID number
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
State ID	Two-letter state identifier used by Medicare (e.g., FL)
Total Expected Reimbursement	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Transfer Payment	Payment amount if UB has a transfer discharge status; in place of DRG Inlier payment