WAC 182-550-7600. OPPS payment calculation

(1) The medicaid agency calculates the enhanced ambulatory patient group (EAPG) payment as follows: EAPG payment = EAPG relative weight x Hospital-specific conversion factor x Discount factor (if applicable) x Policy adjustor (if applicable) (2) The total OPPS claim payment is the sum of the EAPG payments plus the sum of the allowed amounts for each nonEAPG service. (3) If a client's third-party liability insurance has made a payment on a service, the agency subtracts any such payments made from the medicaid allowed amount.