| Payment method used for medicaid inpatient hospital claims | Applicable providers/services | Process to adjust for third-party liability insurance and any other client responsibility |
| Diagnosis related group (DRG) negotiated conversion factor | Hospitals participating in the medicaid hospital selective contracting program under waiver from the federal government | Lesser of either the DRG billed amount minus the third-party payment amount and any client responsibility amount, or the allowed [amount], minus the third-party payment amount and any client responsibility amount. |
| DRG cost-based conversion factor | Hospitals not participating in or exempt from the medicaid hospital selective contracting program | Lesser of either the DRG billed amount minus the third-party payment amount and any client responsibility amount, or the allowed [amount], minus the third-party payment amount and any client responsibility amount. |
| Ratio of costs-to-charges (RCC) | Some services exempt from DRG payment methods | The allowable minus the third-party payment amount and any client responsibility amount. |
| Costs-to-charges rate with a "hold harmless" settlement provision | Hospitals eligible to be paid through the certified public expenditure (CPE) payment program | For the "hold harmless" settlement, the lesser of the billed amount minus the third-party payment amount and any client responsibility amount, or the allowed amount minus the third-party payment amount and any client responsibility amount. The payment made is the federal share only. |
| Single case rate | Hospitals eligible to provide bariatric surgery to medical assistance clients | Lesser of either the billed amount minus the third-party payment amount and any client responsibility amount, or the single case rate allowed amount minus the third-party payment amount and any client responsibility amount. |
| Fixed per diem rate | Long-term acute care (LTAC) hospitals | Lesser of either the billed amount minus the third-party payment amount and any client responsibility amount, or the per diem allowed amount minus the third-party payment amount and any client responsibility amount. |
| Per diem rate | Some providers/services exempt from the DRG payment methods | Per diem allowed amount, and for some services a high outlier amount, minus the third-party payer amount and any client responsibility amount. |
| Cost settlement | DOH-approved critical access hospitals (CAHs) | The allowed amount, subject to retrospective cost settlement, minus the third-party payment amount and any client responsibility amount. |
| Medicaid base community psychiatric hospitalization rate | Nonstate-owned free-standing psychiatric hospitals located in Washington state | Paid according to applicable payment method in WAC 388-550-2650 for medicaid and SCHIP clients, minus the third-party payment amount and any client responsibility amount. |