View the Ohio Medicaid Inpatient Expected Reimbursement Detail
Use the following procedure to view the Ohio Medicaid Inpatient Expected Reimbursement Detail.
Procedure
- Access the Expected Reimbursement Detail page for an Ohio Medicaid Inpatient account. For more information, refer to View the Expected Reimbursement Details .
- Review the expected reimbursements.
Field Descriptions – Ohio Medicaid Inpatient Accounts
The following table describes the fields on the Expected Reimbursement Detail page for Ohio Medicare Inpatient claims.
|
Field |
Description |
|
Capital Allowance |
An allowance for capital costs that is added on to each claim payment |
|
Cost Outlier Payment |
A cost outlier occurs if a hospital's charges exceed a specified amount above the statewide average price. There are two types of outliers: day and cost outliers. The name of this column changes, dependent upon the type of outlier present on the account. |
|
Covered Charges |
The amount of covered charges |
|
Covered Days |
Number of covered days |
|
CTC Ratio |
Facility-specific charge-to-cost ratio
|
|
Day Outlier Payment |
A day outlier occurs if the beneficiary's length of stay exceeds the statewide average by a specified amount. There are two types of outliers: day and cost outliers. The name of this column changes, dependent upon the type of outlier present on the account. |
|
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 Payment |
The DRG payment prior to the addition of allowance and outlier payments |
|
DRG Weight |
DRG weight factor established by Medicare for each DRG |
|
Education Allowance |
An allowance for teaching hospitals that is added to each claim payment |
|
Effective Date |
Effective date of the current contract rates
|
|
Error Code |
Reason for rejection or return, if applicable
|
|
Non-covered Charges |
The amount of non-covered charges (not disallowed charges) |
|
NPI |
Facility’s ten-digit National Provider Identification (NPI) number required on all claims |
|
Provider Number |
Provider’s tax ID number or ten-digit National Provider Identification (NPI) number required on all claims
|
|
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., TX)
|
|
Total 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 |