View the Pennsylvania Medicaid Inpatient Expected Reimbursement Detail

Use the following procedure to view the Pennsylvania Medicaid Inpatient Acute Expected Reimbursement Detail.

The following table describes the fields on the Expected Reimbursement Detail page for Pennsylvania Medicaid Inpatient Acute claims.

Field	Description
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
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
Per Diem Payment	Per diem payment
Provider Number	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 (for example, OK)
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