View the South Carolina Medicaid Inpatient Acute (APR-DRG Payment) Expected Reimbursement Detail

Use the following procedure to view the South Carolina Medicaid Inpatient Acute (APR-DRG Payment) Expected Reimbursement Detail.

Field Descriptions - South Carolina Medicaid Inpatient Accounts

The following table describes the fields on the Expected Reimbursement Detail page for South Carolina Medicaid Inpatient Acute (APR-DRG Payment) claims.

Field	Description
NPI	Facility’s ten-digit National Provider Identification (NPI) number required on all claims.
Effective Date	Effective date of the current contract rates.
Base Rate	The base rate for the facility.
Cost to Charge Ratio	Facility-specific charge-to-cost ratio.
Cost Outlier Threshold	The fixed-loss amount of the system threshold used to determine the outlier threshold set by the state Medicaid. This threshold amount is used in the cost outlier calculation.
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs).
Final APR-DRG	The final APR-DRG used to calculate expected reimbursement.
APR-DRG Weight	The APR-DRG weight factor for the APR-DRG.
Covered Days	Number of covered days.
Covered Charges	The amount of covered charges.
Non-covered Charges	The amount of non-covered charges (not disallowed charges).
DRG Base Payment	The DRG base payment amount.
Low LOS Payment	Displays the payment for Low LOS (length of stay).
Same Day Payment	Displays the same day payment.
Transfer Payment	Payment amount if UB has a transfer discharge status; in place of DRG Inlier payment.
Cost Outlier Payment	A cost outlier occurs if a hospital's charges exceed a specified amount above the statewide average price.
Total Payment	Displays the total payment.
Payment Status	Displays the payment status.
DRG Base Rate	The base rate for the specified DRG.
Payment Status Code	Displays a payment status code to assist facilities in determining the specific calculation used.