View the Florida Medicaid EAPG Expected Reimbursement Detail

Use the following procedure to view the EAPG Expected Reimbursement Detail.

Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.

Field Descriptions – EAPG Reimbursement (prior to 07/01/2022)

The following table describes each of the fields on the Expected Reimbursement Detail page for EAPG claims prior to 07/01/2022. The fields are listed in alphabetical order.

Field	Description
Error Code	The claim-level error or message code.
NPI	Facility’s ten-digit National Provider Identification (NPI) number required on all claims.
Effective Date	Effective date of the current contract rates.
Grouper Type	The type of DRG grouper used for this contract profile: EAPG.
Grouper Version	The EAPG grouper version used for this contract profile.
Base Rate	The base rate for the facility.
Automatic Rate Enhancement	Facility specific state regulated rate enhancement.
Reimbursement Type	The reimbursement type, either expected reimbursement or RA, for each line item (the latest RA is shown if there are multiple RAs).
Service Date	The date of service for each line item.
Revenue Code	The revenue code for each line item on the claim.
HCPC/CPT Code and Modifier	The associated CPT or HCPC code, and modifier for each line item on the claim.
Billed Units	The number of units billed for each line item.
Charges	Total amount billed by the provider for each line item.
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 (e.g. Unassigned, Radiologic Procedure, Ancillary, Medical Visit, Drug) so you can quickly determine why certain line items are paid, packaged, or not paid reducing line item research.
Expected Payment	The expected payment. It is calculated by multiplying the EAPG Weight by the EAPG Base rate defined for the service type.
Payment Percent	Percent of the calculated payment allowed.
Pricing Status	Indication of payment calculation.
Edit Code	The code for Procedure, Revenue Code, or Relationship edits for not processing claim line.

Field Descriptions – EAPG Reimbursement (effective 07/01/2022)

The following table describes each of the fields on the Expected Reimbursement Detail page for EAPG claims effective 07/01/2022. The fields are listed in alphabetical order.

Field	Description
Error Code	The claim-level error or message code.
NPI	Facility’s ten-digit National Provider Identification (NPI) number required on all claims.
Effective Date	Effective date of the current contract rates.
Grouper Type	The type of DRG grouper used for this contract profile: EAPG.
Grouper Version	The EAPG grouper version used for this contract profile.
Base Rate	The base rate for the facility.
Provider Policy Adjustor	Displays a numerical multiplier used in the Enhanced Ambulatory Patient Grouping (EAPG) payment methode for Medicaid in Florida.
Childrens Per Serv Add-on Payment	Facility specific state regulated rate enhancement for children’s hospitals.
Reimbursement Type	The reimbursement type, either expected reimbursement or RA, for each line item (the latest RA is shown if there are multiple RAs).
Service Date	The date of service for each line item.
Revenue Code	The revenue code for each line item on the claim.
HCPC/CPT Code and Modifier	The associated CPT or HCPC code, and modifier for each line item on the claim.
Billed Units	The number of units billed for each line item.
Charges	Total amount billed by the provider for each line item.
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 and description (e.g. Unassigned, Radiologic Procedure, Ancillary, Medical Visit, Drug) so you can quickly determine why certain line items are paid, packaged, or not paid reducing line item research.
Add-on Payment	State regulated add on payment for services.
EAPG Payment	The expected payment. It is calculated by multiplying the EAPG Weight by the EAPG Base rate defined for the service type.
Payment Percent	Percent of the calculated payment allowed.
Pricing Status	Indication of payment calculation. (Includes indicator description.)
Edit Code	The code for Procedure, Revenue Code, or Relationship edits for not processing claim line.