View the Pennsylvania Medicaid Outpatient Expected Reimbursement Detail
Use the following procedure to view the Pennsylvania Medicaid Outpatient Expected Reimbursement Detail.
Procedure
- Access the Expected Reimbursement Detail page for a Pennsylvania Medicaid Outpatient account. For more information, refer to View the Expected Reimbursement Details .
- Review the expected reimbursements.
Field Descriptions – Pennsylvania Medicaid Outpatient Accounts
The following table describes the fields on the Expected Reimbursement Detail page for Pennsylvania Medicaid Outpatient claims.
|
Field |
Description |
|
Billed HCPC/CPT Code |
Associated CPT or HCPC codes billed to the account |
|
Billed Units |
Number of units billed |
|
Covered Charges |
The amount of covered charges |
|
Effective Date |
Effective date of the current contract rates |
|
Error Code |
Reason for rejection or return, if applicable |
|
Fee Schedule Rate |
The base fee schedule rate |
|
NPI |
Facility’s ten-digit National Provider Identification (NPI) number required on all claims |
|
Paid Units |
Number of units paid |
|
Provider Number |
Provider’s tax ID number or ten-digit National Provider Identification (NPI) number required on all claims |
|
Reason Code |
Reason for rejection or return, if applicable |
|
Reimbursement Type |
Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs) |
|
Revenue Code |
Revenue code |
|
Service Date |
Date the service was rendered |
|
State ID |
Two-letter state identifier used by Medicare (e.g., PA) |
|
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 |