ForwardHealth uses the Enhanced Ambulatory Patient Group (EAPG) classification system to calculate pricing for outpatient hospital claims. The groups used in the EAPG system categorize the amount and type of resources used in various outpatient visits. Under the EAPG classification system, reimbursement for outpatient hospital services is based on the quantity and type of services provided. The system ensures that both low- and high-cost services are reimbursed appropriately.
The EAPG reimbursement methodology applies to fee-for-service members enrolled in BadgerCare Plus, Wisconsin Medicaid, and the Wisconsin Chronic Disease Program.
EAPG was implemented for fee-for-service claims on April 1, 2013, and extended to HMO encounters on January 1, 2015. ForwardHealth continues to publish rate-per-visit information for county jail reference. Current version information and installation dates for the EAPG Grouper, the 3M Grouper Plus Content Services (GPCS) platform, and the APR DRG Grouper can be found on the Hospital Rates and Weights Portal page.
The following presentations were developed for HMO EAPG implementation. However, most of the content is applicable to both fee-for-service claims and HMO encounters.
Current and archived EAPG rates and weights are available.
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