OCE Purpose

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