View the TRICARE (Outpatient CAH) Expected Reimbursement Detail

Use the following procedure to view the TRICARE Outpatient Critical Access Hospital (CAH) Expected Reimbursement Detail.

The information on the Expected Reimbursement Detail page for TRICARE Outpatient CAH accounts is different from that of other TRICARE accounts.

Field Descriptions – TRICARE Outpatient CAH Accounts

The following table describes each of the fields on the Expected Reimbursement Detail page for TRICARE Outpatient Critical Access Hospital (CAH) claims. The fields are listed in alphabetical order.

Field	Description
Allowed Units	Number of units allowed by reimbursement logic
Billed Charges	Total billed charges for the product during the selected time period
Billed Units	Number of units billed
Code Type	Type of code, such as REV, DRG, HCPC, and so on.
CPT/HCPC Codes & Modifiers	Associated CPT or HCPC codes and modifiers
Error Code	Reason for rejection or return (claim level), if applicable
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
Fee Schedule Payment	Total reimbursement from a fee schedule (Lab, DMEPOS, PEN and therapies)
MSA Payment	Metropolitan Statistical Area (MSA) payment. For CAH, the MSA payment should always be zero, due to the type of calculation required for CAH.
Other Payment	The total CAH calculation
Pass-Through Payment	Total reimbursement for certain high-cost items like implants, high cost drugs and biologicals for which the actual or higher cost is passed through to the payor
Reason Code	Reason a specific line item was denied or description of how it was paid
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 Expected Reimbursement	Total expected reimbursement on the claim