Which term represents the maximum reimbursement calculated by the contract build in Epic?

• A. Billed Amount (Contracts Term)
• B. Not Allowed Amount (Posting Term)
• C. Allowed Amount (Contract term)
• D. Expected Amount (Contracts Term)

Answer: (D)

In Epic pricing, several monetary figures are used to describe how much a payer will reimburse under a contract. The term that captures the contract-build’s forecasted reimbursement—the maximum amount the contract would authorize for the claim—is the Expected Amount. This value is derived by applying the contract’s pricing rules, such as negotiated rates and policy exclusions, to the billed charges. It represents the upper bound of reimbursement the system expects under the contract, before final post-adjudication adjustments like patient responsibility or denials. It is distinct from the billed amount (what the provider billed), the allowed amount (the maximum the payer will approve under the contract for that service, which can be different from the billed amount), and the not allowed amount (the portion of the allowed amount that the payer denies).