View the TRICARE (Acute Inpatient) Expected Reimbursement Detail
Use the following procedure to view the expected reimbursement detail for TRICARE Acute Inpatient accounts.
Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.
Procedure
- Access the Expected Reimbursement Detail page for a TRICARE Acute Inpatient account. For more information, refer to View the Expected Reimbursement Details .
- Review the expected reimbursements.
Field Descriptions – TRICARE Acute Inpatient Accounts
The following table describes each of the fields on the Expected Reimbursement Detail page for TRICARE acute inpatient claims. The fields are listed in alphabetical order.
|
Field |
Description |
|
Billed Charges |
Total billed charges for the product during the selected time period
|
|
Blood Clotting Factor Payment |
Payment amount if claim includes relevant codes |
|
Cov Charges |
Amount of charges covered |
|
Covered Days |
Number of covered days
|
|
DRG |
Diagnosis Related Group. If the DRG was submitted with a Severity of Illness code, it displays as DRG-Severity Code, for example, 001-2.
|
|
DRG Inlier Payment |
Base payment for all TRICARE claims |
|
DRG Weight |
DRG weight factor for each DRG |
|
Error Code |
Reason for rejection or return (claim level), if applicable
|
|
New Tech Add On |
Displays the New Tech add on amount |
|
New Tech VBP Adjustment |
Displays the New Tech value base purchasing adjustment |
|
Operating VBP Adjustment |
Displays the operating value base purchasing adjustment |
|
Outlier Payment |
Total amount paid for extraordinarily high cost, in addition to the DRG payment |
|
Pass-Through Amount |
Total reimbursement for certain high-cost items, such as transplant donors and blood factors, for which the actual or higher cost is passed through to the payor |
|
Reimbursement Type |
Reimbursement type |
|
Short Stay Outlier Payment |
Payment amount if stay is equal to or less than the Low Day Trim |
|
Total Reimbursement |
Total expected reimbursement on the claim |
|
Transfer Payment |
Payment amount if UB has a transfer discharge status; in place of DRG Inlier payment |