View the New York Medicaid OP Expected Reimbursement Detail (EAPG)

Use the following procedure to view the New York Medicaid Expected Reimbursement Detail for outpatient accounts using EAPG.

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

Field Descriptions – New York Medicaid OP Accounts (EAPG)

The following table describes the fields on the Expected Reimbursement Detail page for New York Medicaid OP claims using EAPG.

Field	Description
Action or Error Code	A code that denotes the payment action or exclusion at the claim line level, which explains the method of payment calculation.
Add-on Payment	Provider-specific payment that varies between the three hospital-based APG services and that will be added to the operating payment for each visit.
Allowed Units	Number of units allowed by reimbursement logic.
APG Adjusted Weight	Factor adjusted by blended and transition logic and then assigned to an APG that is used to calculate the specific payment for that APG.
APG Description	Medical APGs pay based on patient’s condition and service intensity (diagnosis and procedure) and utilize comprehensive packaging and bundling.
APG Weight	Factor assigned to each APG that is used to calculate the specific payment for that APG. Ratio of the relative complexity of the APG to the average complexity of all APGs.
Billed Units	Number of units billed.
Blended Payment	Factor adjusted by blended and transition logic and then assigned to an APG that is used to calculate the specific payment for that APG.
Blended Payment Percent	The percentage of the total payment based on the old reimbursement methodology (for example, 75% at initial implementation, 50% in 2010, and so on) applied to the facility-specific average payment throughout the period of the transition to full payment based on APGs.
Claim Line Edit Codes	Code for Procedure, Revenue Code, or Relationship edits for not processing claim line.
Covered Charges	Amount of charges covered by Medicaid.
Edit Code Description	Description of the code for Procedure, Revenue Code, or Relationship edits for not processing claim line.
Effective Date	Effective Date.
Error Code	The reason for rejecting or returning the claim, if applicable.
Error Code Description	Description of the error code at claim level.
Exiting Payment	Facility-specific average rate of payment calculated by dividing all Medicaid revenue by all Medicaid visits for services moving to APGs.
Final APG	APG which all services have been rolled under for processing reimbursement and doing final calculation.
Final APG Type	Code which denotes the packaging, bundling, and categorizing for multiple interrelated services into a single type group.
HCPC/CPT Code & Modifier	Associated CPT or HCPC codes and modifiers.
NPI	Facility’s ten-digit National Provider Identification (NPI) number required on all claims
Provider Number	Provider Number.
Rate Code Service	Facility’s location of service associated with a specific base rate.
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.
State ID	The two-letter state identifier.
Total Add-On Payment	Provider-specific payment that varies between the three hospital-based APG services and that will be added to the operating payment for each visit.
Total Blended Payment	The percentage amount of the total payment based on the new reimbursement APG methodology. This amount is then applied to the facility-specific average payment throughout the period of the transition to full payment based on APGs.
Total Existing Payment	The total blend amount which applies only to all free-standing services, both clinic and ambulatory surgery, which has been Calculated using CY 2007 claims data and frozen throughout the period of the phase-in.
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.
Total Non-Transition Payment	The percentage amount of the total payment based on the old reimbursement methodology. This amount is then applied to the facility-specific average payment throughout the period of the transition to full payment based on APGs.
Total Payment	The total insurance and patient payments posted to the account, as defined in the data.
Total Transition Payment	The percentage amount of the total payment based on the old reimbursement methodology. This amount is then applied to the facility-specific average payment throughout the period of the transition to full payment based on APGs.
Total Visit APG Payment	The percentage amount of the total payment based on the grouping of APG Types. This amount is then applied to the facility-specific average payment throughout the period of the transition to full payment based on APGs.