Use the TRICARE OPPS Calculator

Use the TRICARE OPPS Calculator to calculate the expected reimbursement for TRICARE Outpatient claims.

  1. To access the TRICARE OPPS Outpatient Calculator page, select Go To > Government Payor Research > TRICARE > OPPS Outpatient Calculator.

    Note: If your facility shares its database with other facilities, a Facility drop-down list appears that lets the you select the correct facility.

  2. Specify the calculation criteria and optional values. For more information about each calculation criteria, refer to the Field Descriptions table below.
  3. To add or remove lines for line item entry:
    • Click +1, +5, or +10 to add one, five or ten additional lines. The maximum number of Line Item Entries is 200.
    • Click - to delete a line.
  4. Click Calculate. The results appear. For more information, refer to View the TRICARE Non-OPPS Calculator Results.

    Note: This screen refreshes every 15 minutes. If you are adding Line Item Entries when the window refreshes, all entered information will be saved, however, all blank lines (except the original five) will be deleted.

The following table describes each of the fields on the TRICARE Non-OPPS Calculator page.

Field

Description

Patient Information

Patient Gender

Patient gender

Date of Birth

Patient birth date

Claim Information

Service From

First date of service rendered to the patient. This is required information, and defaults to today’s date. Cannot be prior to Date of Birth.

Service To

Ending date the service was performed; required information; defaults to today’s date. Cannot be prior to Service From date.

Discharge Status

Patient’s destination upon discharge (home, LTC, and so on)

Bill Type

Bill type

Condition Codes

A two-digit code identifying a condition that affects processing and payment of the claim.

Note: Condition codes indicate whether coverage exists under another insurance, whether the injury or illness is related to employment, whether the bill is an outlier, or if medical necessity affects room assignment.

Diagnosis Codes

ICD Diagnosis Codes

Line Item Entry

No.

Sequential number of the account in the current set of accounts, based on the sort method

Revenue Code

Revenue code

CPT/HCPC Code

Associated CPT or HCPC codes

Service Date

Date the service was rendered

Units

Number of units billed

Total Charges

Charged amount