Purpose of the OPPS I/OCE functionality

The Integrated Outpatient Code Editor (I/OCE) software combines editing logic with the new APC assignment program designed to meet the mandated OPPS implementation. The software performs the following functions when processing a claim:

• Edits a claim for accuracy of submitted data
• Assigns APCs
• Assigns CMS-designated status indicators
• Assigns payment indicators
• Computes discounts, if applicable
• Determines a claim disposition based on generated edits
• Determines if packaging is applicable
• Determines payment adjustment, if applicable

Purpose of the non-OPPS I/OCE functionality

In addition to its editing function, the I/OCE program screens each procedure code against a list of approximately 2500 ASC procedures, and summarizes whether or not the bill is subject to the ASC limitation.

Appendix A contains lists of codes associated with program edits for both OPPS and non-OPPS processing

Downloads
Appendix F(a) OCE Edits Applied by Bill Type (OPPS flag =1) [PDF 70KB] Appendix F(b) OCE Edits Applied by Non-OPPS Hospital Bill Type (OPPS flag = 2) [PDF 72KB] Pub 100-21 [PDF 225KB] Description of edits/claim reasons Table [PDF 58KB]
Related Links Inside CMS
System Requirements Shared System Maintainers install OCE updates into their systems. Providers can view OCE edits via Direct Data Entry MLN Matters Articles Hospital Outpatient Overview PPS National Correct Coding Initiative (NCCI) Edits Transmittal Page Outpatient PPS Pricer
Related Links Outside CMS
National Technical Information Service (NTIS)

Page Last Modified: 10/07/2008 8:45:23 AM
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