View the Florida Medicaid Outpatient Expected Reimbursement Detail
Use the following procedure to view the Florida Medicaid Outpatient Expected Reimbursement Detail.
Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.
Procedure
- Access the Expected Reimbursement Detail page for a Florida Medicaid Outpatient account. For more information, refer to View the Expected Reimbursement Details .
- Review the expected reimbursements.
- If the account exceeds the outpatient cap, a message displays at the bottom of the expected reimbursement details to indicate that the outpatient cap was applied.
- Optionally, you can perform the following actions:
- Click Reimbursement to display the View Contract Profile page. For more information, refer to View a Contract Profile.
- Click the Service Type name to display the service types on the View Contract Profile page. For more information, refer to View a Contract Profile.
- Click View in the Calculation Details column. The Calculation Details page opens. For more information, refer to View Expected Reimbursement Calculation Details.
Field Descriptions – Florida Medicaid Outpatient Accounts
The following table describes the fields on the Expected Reimbursement Detail page for Florida Medicare 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 |
|
Lab Payment |
Amount of the laboratory service technical fee calculated from the Outpatient Hospital Laboratory fee schedule. |
|
NHS Program Payment |
Medicaid reimburses the initial newborn hearing screening procedure as a supplement to the usual per diem |
|
NPI |
Facility’s ten-digit National Provider Identification (NPI) number required on all claims |
|
Outpatient Cap |
Recipients 21 years old or older are limited to a $1500 entitlement per fiscal year (July to June); this field is only displays a cap amount when applicable |
|
Outpatient Line Item Rate |
Florida Medicaid pays a line item rate for outpatient hospital services. A line item rate applies one time to each covered outpatient revenue center code billed, regardless of the charges. If the total expected reimbursement is zero, this column also displays a zero. |
|
Revenue Code |
Revenue code |
|
Service Date |
Date the service was rendered |
|
State ID |
Two-letter state identifier used by Medicare (e.g., FL) |
|
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 |