View the Nebraska Blue Cross Blue Shield EAPG Expected Reimbursement Detail
Use the following procedure to view the Nebraska Blue Cross Blue Shield EAPG Expected Reimbursement Detail information.
Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.
Procedure
- Access the Expected Reimbursement Detail page for a Nebraska Blue Cross Blue Shield EAPG 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 – Nebraska Blue Cross Blue Shield EAPG Accounts
The following table describes the fields on the Expected Reimbursement Detail page for Nebraska Blue Cross Blue Shield EAPG claims.
|
Field |
Description |
|
Error Code |
The reason for rejecting or returning the claim, if applicable. |
|
NPI |
Facility’s ten-digit National Provider Identification (NPI) number required on all claims |
|
Effective Date |
Effective Date of the current contract rates. |
|
Grouper Version |
The current version used in the outpatient calculation. |
|
Grouper Type |
The actual grouper type used for the outpatient calculation. |
|
Base Rate |
Factor assigned by the payor for individual hospitals used in the total expected calculations. |
|
EAPG Payment |
Total payment based on EAPG calculation. |
|
Other Payment |
Total payment based on non-EAPG calculations. |
|
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. |
|
Reimbursement Type |
Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs). |
|
Service Date |
Date the service was rendered. |
|
Revenue Code |
Revenue code. |
|
HCPC/CPT Code & Modifier |
Associated CPT or HCPC codes and modifiers billed to the account. |
|
Billed Units |
Number of units billed. |
|
Charges |
Total billed charges for the line item. |
|
Final EAPG |
The EAPG that the CPT code on each line is grouped. |
|
EAPG Weight |
The weight assigned to each EAPG by the grouper. |
|
Expected Percent |
Displays the expected percent. |
|
Final EAPG Type |
Displays the final EAPG type. |
|
Payment Percent |
Displays the pricing percentage. |
|
Pricing Status |
Indicator of how the line item is reimbursed (Full Payment/EAPG, ATP Eligible, Alt/Other Payment, etc.). |
|
Edit Code |
The code for Procedure, Revenue Code, or Relationship edits for not processing claim line. |