View the Ohio Medicaid Outpatient Expected Reimbursement Detail

Use the following procedure to view the Ohio Medicaid Outpatient Expected Reimbursement Detail.

  1. Access the Expected Reimbursement Detail page for an Ohio Medicaid Outpatient account. For more information, refer to View the Expected Reimbursement Details .
  2. Review the expected reimbursements.

The following table describes the fields on the Expected Reimbursement Detail page for Ohio Medicare Outpatient claims. 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, if applicable

Source: BILLMCAD.ERRCODE

NPI

Facility’s ten-digit National Provider Identification (NPI) number required on all claims

Effective Date

Effective date of the current contract rates

Source: MCAPROV.EFF_DATE

Grouper Type

The actual grouper type used for this outpatient calculation.

Grouper Version

The current version used in this outpatient calculation.

Base Rate

Factor assigned by state for individual hospitals to be used in the total expected calculation.

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.

Reimbursement Type

Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)

Service Date

Date the service was rendered

Source: BILLMCAD.SERVDATE

Revenue Code

Revenue code

Source: UB-92, FL42; UB-04, FL42;

BILLMCAD.REVCODE

HCPC/CPT Code & Modifier

Associated CPT or HCPC codes and modifiers billed to the account

Source: UB-92, FL44; UB-04, FL44

BILLMCAD.CPTCODE

Billed Charges

Amount of charges covered by Medicaid.

Billed Units

Number of units billed

Source: UB-92, FL46; UB-04, FL46

BILLMCAD.UNITS

Allowed Units

Number of units allowed by reimbursement logic.

Final EAPG

The EAPG that the CPT code on each the line was grouped to.

EAPG Weight

The weight assigned to each EAPG by the grouper.

Final EAPG Type

Displays the final EAPG type

Expected Percent

Displays the expected percent

Pricing Percent

Displays the pricing percent

Edit Code

The code for Procedure, Revenue Code, or Relationship edits for not processing claim line.

EAPG Description

Description of the EAPG.