View the Texas Medicaid Inpatient Acute Expected Reimbursement Detail
Use the following procedure to view the Texas Medicaid Inpatient Acute 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 Texas Medicaid Inpatient Acute account. For more information, refer to View the Expected Reimbursement Details .
- Review the expected reimbursements.
- 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 – Texas Medicaid Inpatient Acute
The following table describes the fields on the Expected Reimbursement Detail page for Texas Medicaid Inpatient Acute claims.
|
Field |
Description |
|
Covered Charges |
Amount of charges covered by Workers’ Compensation or Medicare |
|
Covered Days |
Number of covered days |
|
DRG |
Diagnosis Related Group. If the DRG was submitted with a Severity of Illness code, it displays as DRG-Severity Code, for example, 001-2. |
|
DRG Weight |
DRG weight factor, established by Medicare for each DRG |
|
Effective Date |
Effective date of the current contract rates |
|
Error Code |
Reason for rejection or return, if applicable |
|
IP CTC Ratio |
Facility-specific inpatient charge-to-cost ratio |
|
Medicaid Payment |
Basic Medicaid reimbursement for a procedure |
|
Non Covered Charges |
The amount of non-covered charges (not disallowed charges) |
|
Outlier Payment |
Payment for extraordinarily high cost (cost outlier) |
|
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) |
|
State ID |
Two-letter state identifier used by Medicare (e.g., TX) |
|
Total CHIRP Percentage |
Displays the total Comprehensive Hospital Increase Program (CHIRP) percentage |
|
Total PPE Reduction |
Dislays the PPE reduction (PPC reduction + PPE reduction) |
|
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. Transfer in accounts are calculated by the system at the full DRG payment, but these accounts are sometimes reimbursed as a per diem calculation. If the admit source (UB92, FL20 or UB04, FL15) equals 04, the total reimbursement value is a hyperlink that opens the Account Override Verification page to provide quick access to overriding the account when necessary. |
|
Universal Mean |
Mean dollar value for the provider accounts |