View the Medi-Cal Outpatient Expected Reimbursement Detail
Use the following procedure to view the Medi-Cal Expected Outpatient Reimbursement Detail.
Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.
Procedure
- Access the Expected Reimbursement Detail page for a Medi-Cal account. For more information, refer to View the Expected Reimbursement Details .
- Review the expected reimbursements.
- Optionally, you can perform the following actions:
- Click View in the Calculation Details to display the Calculation Details page. For more information, refer to View Expected Reimbursement Calculation Details.
- Click Re-calculate as Medicare OPPS to display the Medicare Outpatient Calculator. For more information, refer to Use the Medicare Outpatient Calculator.
- Click Re-calculate as TRICARE Non-OPPS to display the TRICARE Non-OPPS Calculator. For more information, refer to Use the TRICARE Non-OPPS Calculator.
Field Descriptions – Medi-Cal Outpatient Reimbursement
The following table describes the fields on the Expected Reimbursement Detail page for Medi-Cal claims.
|
Field |
Description |
|
Billed HCPC/CPT Code |
Associated CPT or HCPC codes billed to the account |
|
Billed Charges |
The total charges incurred for the claim or set of claims that have been repriced |
|
Billed Units |
Number of units billed |
|
Case/Per Diem Rate |
Case or per diem rate reimbursement |
|
DSH Rate |
Disproportionate Share Hospital reimbursement rate, as defined by Medicare |
|
Effective Date |
Effective date of the current contract rates |
|
Error Code |
Reason for rejection or return, if applicable |
|
Fee Schedule Payment |
Total reimbursement from a fee schedule (Lab, DMEPOS, PEN and therapies) |
|
Line Error |
Error code for a line item |
|
No. |
Sequential reference number of the line item |
|
Ortho Bump |
Ortho bump add on payment |
|
Paid Units |
Quantity paid |
|
Provider Number |
Provider’s tax ID number or ten-digit National Provider Identification (NPI) number required on all claims |
|
Reimb. HCPC/CPT Code |
Reimbursed CPT and HCPC codes |
|
Revenue Code |
Revenue code |
|
Service Date |
Date the service was rendered |
|
State ID |
Two-letter state identifier used by Medicare (e.g., CA) |
|
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 |