View the TRICARE (Outpatient) Expected Reimbursement Detail

Use the following procedure to view the expected reimbursement detail for TRICARE Outpatient accounts with the Non-OPPS logic applied.

Note: For more information about the TRICARE OP reimbursement terms, refer to TRICARE Outpatient (OP) Tab.

Field Descriptions – TRICARE Outpatient Accounts

The following table describes the fields on the Expected Reimbursement Detail page for TRICARE Outpatient claims when the Non-OPPS logic is applied.

Field	Description
Allowed Percent	Allowed percent as pertains to MSA
Allowed Units	Number of units allowed by reimbursement logic
Billed Charges	Amount billed by the provider for the line item
Billed Units	Number of units billed for the line item
Code Type	Type of code: S – Surgical Code I – Injectable Code C – CMAC Code N – No Pay Government Code A – Ambulance Code W – State Prevailing CMAC Code V – State Prevailing Surgical Code T – Transplant Donor P – Psych
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 for the line item, 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 grouped surgical procedures
No.	Sequential reference number of the line item
Other Payment	Non-fee schedule payments (percent of charges)
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.
Rate	Fee schedule rate
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)
Rev Code	Revenue code
Service Date	Date the service was rendered
Total Expected Reimbursement	Total expected reimbursement on the claim