Massachusetts

The reimbursement rate is calculated using the base weight (determined by the state Medicaid) and the contract values entered in this node.

Reimbursement Rate = Base Weight * Node Contract Values

Refer to the contract to determine the values to enter for the foll owing required fields:

  • Percent Reimbursement – Type the applicable percentage amount. The default value is 100% and the value is line item reduced.

The following table describes the fields on the MA tab of the Medicaid - Facility reimbursement tool.

Field

Description

Override Provider Number

The override number for the provider.

Override Service Date

Not available at this time.

State Code

This field defaults to MA, and it cannot be changed.

Do not consume charges

Not available at this time.

Do not consume units

Not available at this time.

Percent Reimbursement

Three digit percentage amount. The default value is 100%.

Cap line items at lesser of billed charges or Medicaid reimbursement

Select this check box to allow line items to price the lesser of billed charges or Medicaid reimbursement. This option does not apply to inpatient or physician services. This check box is unchecked as the default.

Price to zero on error

Enable (check) this option to include accounts that fail to price due to an error display with an expected reimbursement amount of zero ($0). When this check box is disabled (not checked), accounts price to 100% of billed charges.