View the Minnesota Medicaid IP Expected Reimbursement Detail

Use the following procedure to view the Minnesota Medicaid Expected Reimbursement Detail.

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

Field Descriptions – Minnesota Medicaid IP Accounts

The following table describes the fields on the Expected Reimbursement Detail page for Minnesota Medicaid Inpatient claims.

Field	Description
Base DRG Payment	The DRG payment prior to the addition of outlier payments
Covered Days	Number of covered days
CTC Ratio	Facility-specific charge-to-cost ratio
Day Outlier Payment	An admission whose length of stay exceeds the geometric mean length of stay for neonate and burn diagnostic categories by one standard deviation and all other diagnostic categories by two standard deviations qualifies for a day outlier payment
Disproportionate Share Payment Factor	Displays the disproportionate share payment factor determined by the Minnesota administrative code
DRG	Diagnosis Related Group.
DRG Weight	DRG weight factor established by Medicaid for Minnesota for each DRG
Effective Date	Effective date of the current contract rates
Error Code	Reason for rejection or return, if applicable
HAC Adjusted DRG	The Hospital Acquired Conditions (HAC) adjusted DRG.
Minnesota DRG	Payment rates are prospectively established on a per admission or per day basis under a diagnosis related group (DRG) system that condenses Medicare categories into Minnesota diagnosis categories
Newborn Screening Add On	Reimbursement for newborn screening add on
Per Diem Rate	Amount reimbursed per day
Provider Number	Provider’s tax ID number or ten-digit National Provider Identification (NPI) number required on all claims
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
Service From	First date of service rendered to the patient
Service To	Last date of service rendered to the patient
State ID	Two-letter state identifier used by Medicaid, for example, “MN.”
Total Expected Reimbursement	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Transfer Payment	Payment amount if UB has a transfer discharge status; in place of DRG Inlier payment
Wage Adjusted Base Rate	Wage adjusted base rate as determined by the Minnesota administrative code
Medicaid Reimbursement (RA)
Billed Charges	The total charges incurred for the claim or set of claims that have been repriced
Charges (RA)	Total charges associated with the RA
CPT/HCPC Code & Modifiers	Associated CPT or HCPC codes and modifiers
Deductible (RA)	Total deductible listed on the RA
Expected Discount	Billed Charges minus non-covered charges, minus Total Expected Reimbursement
Expected Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Insurance Payment	The amount paid by the insurance company
Insurance Payment (RA)	The amount paid by the insurance company on this RA
No.	Line number for the RA data entry; this number is a link that shows/hides the line item detail
Patient Payment	Portion paid by the patient
Patient Payment (RA)	Portion paid by the patienton this RA
Payment Codes (RA)	Used to explain the payment of the account; defined in the Remittance Payment Codes table
RA Claim Status	Explanation of the RA claim status code used in the Reimbursement Type column
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
Revenue Code	Revenue code.
Service Date	Date the service was rendered
Total Payment (RA)	The total insurance and patient payments on this RA
Units (RA)	Number of units used for Remittance Advice purposes