About grouping and pricing APC and eAPG claims

Many contracts include clauses or terms that include APC Ambulatory Patient Classification. In most cases, this is the unit of payment under the Outpatient Prospective Payment System (OPPS). or eAPG Enhanced Ambulatory Patient Grouping System provided by 3M. This system calculates pricing for outpatient hospital claims. reimbursement methods. Before these contracts can be calculated, the claim line items need to be grouped and priced into APCs or eAPGs. Group and Price allows Admin users to queue up a single claim or a group of claims as needed.

NOTE: Grouping and pricing is available only for institutional A claim billed from a hospital or institution as opposed to billing from a physician's office. outpatient claims.

Grouping and pricing is usually done during the nightly import. However, you may need to group and price claims on demand; for example, new simulation contracts and changes to existing contracts do not generate a Group/Price task automatically, so you need to set these up manually.

The Group and Price Claims page in the Claims section of Axiom Contract Management enables you to set up, save, and execute claim grouping and pricing tasks. For information, see Group and price APC and eAPG claims.

Additionally, you can also use the Shift Date By feature to view a forecast of how new schedules will affect claims for the coming year.