Enhanced Ambulatory Patient Group (EAPG) for Outpatient Hospital Services
DATE: May 29, 2015
TO: All Hospitals
FROM: Virginia Premier Health Plan, Inc. (VPHP)
SUBJECT: Enhanced Ambulatory Patient Group (EAPG) for Outpatient Hospital Services
Effective for claims with dates of service on or after January 1, 2014, Virginia Premier Health Plan, Inc. will reimburse outpatient hospital services using the Enhanced Ambulatory Patient Group (EAPG) payment methodology. The pend and review process for emergency room (ER) services will be eliminated. Therefore, hospitals will no longer be required to submit documentation of emergency services for services determined to be non-emergent.
The EAPG payment methodology will replace the triage payment previously reimbursed to hospitals for all non-emergent services. Please reference the Medicaid Memo dated November 8, 2013 for additional details.
No further action is required at this time. However, should you have any questions please contact Provider Services toll free at 800-727-7536 option 6 Monday through Friday from 8 a.m. to 5 p.m.
Thank you for continuing to provide quality care to our members.
Sincerely,
Patrick McMahon
VP, Network Development