MC_PRICER_IOCE

Description: |
Data returned from IOCE Editor.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
PRICER_MSG_ID | 1 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | PRICER_MSG_ID | NUMERIC | No |
The unique identifier for the Epic Pricer message record.
2 | IOCE_RTN_CODE_C_NAME | VARCHAR | No |
IOCE return code.
May contain organization-specific values: No
Category Entries:
Claim processed successfully
Memory allocation error (obsolete)
Run-time environment initialization failed (obsolete)
Could not open read-only table file (obsolete)
Could not determine read-only table size (obsolete)
No memory for read-only table (obsolete)
Read error loading Read-Only Table file
Read-only table file corrupted (obsolete)
Read-only tables file wrong version (obsolete)
Could not link tables to base object (obsolete)
OCEInit not called before call to OCECLM (obsolete)
Zero line items
Invalid "From" date
Invalid "Through" date
Invalid date sequence
At least one line has an invalid date
"From" date outside version range
Invalid type of bill
Claim not processed, bill type 12x or 14x present with CC 41
Contractor Override – specified edit not present in EditBypass table
Contractor Override – non-numeric value specified for numeric-only field
Contractor Override – non-numeric value specified for value code amount field
Receipt Date – date invalid or outside of IOCE version range
3 | IOCE_PROCESSD_C_NAME | VARCHAR | No |
IOCE processed flag.
May contain organization-specific values: No
Category Entries:
Claim processed
Claim could not be processed (edits 23, 24, 46, 118, 119)
Claim could not be processed (claim has no line items)
Claim could not be processed (Reserved)
Fatal error; claim could not be processed as input values are not valid or are incorrectly formatted; exit immediately
Fatal error occurred - the OCE environment cannot be created, exiting immediately
4 | IOCE_CLM_DISP_C_NAME | VARCHAR | No |
IOCE claim disposition.
May contain organization-specific values: No
Category Entries:
No edits are present on the claim
The only edits present are for line item denial or rejection
Claim is for multiple days with one or more days denied or rejected
Claim is denied, rejected, suspended or returned to provider, or single day claim with all line items denied or rejected, with only post-payment edits
Claim is denied, rejected, suspended or returned to provider, or single day claim with all line items denied or rejected, with only pre-payment edits
Claim is denied, rejected, suspended or returned to provider, or single day claim with all line items denied or rejected, with both post- and pre- payment edits
5 | IOCE_PAY_APC | VARCHAR | No |
IOCE payment APC.
6 | IOCE_STATUS_IND_C_NAME | VARCHAR | No |
IOCE status indicator.
May contain organization-specific values: No
Category Entries:
Services not paid under OPPS; paid under fee schedule or other payment system
Non-allowed item or service for OPPS
Inpatient procedure
Non-allowed item or services
Non-allowed item or service
Items and services for which pricing information and claims data are not available
Corneal tissue acquisition; certain CRNA services
Drug/biological pass-through
Pass-through device categories
Outpatient department services paid through a comprehensive APC
Hospital Part B services that may be paid through a comprehensive APC
Non pass-through drugs and non-implantable biologicals, including therapeutic radiopharmaceuticals
Influenza Vaccine; Pneumococcal Pneumonia Vaccine; Hepatitis B Vaccines; Covid-19 Vaccine; Monoclonal Antibody Therapy Product
Service not billable to the MAC
Items and services packaged into APC rates
Partial Hospitalization or Intensive Outpatient Program
STV-packaged codes
T-packaged codes
Codes that may be paid through a composite APC
Conditionally packaged laboratory services
Blood and blood products
Significant procedure not subject to multiple procedure discounting
Significant procedure subject to multiple procedure discounting
Brachytherapy sources
Clinic or emergency department visit
Invalid HCPCS or invalid revenue code with blank HCPCS
Non-implantable DME
Valid revenue code with blank HCPCS and no other SI assigned
Non-Opioid Medical Devices for Post-Surgical Pain Relief
Non-Opioid Drugs and Biologicals for Post-Surgical Pain Relief
Skin substitute product paid separately
Unknown Value
7 | IOCE_PAYMENT_IND_C_NAME | VARCHAR | No |
IOCE payment indicator.
May contain organization-specific values: No
Category Entries:
Paid standard hospital OPPS amount
Services not paid by OPPS Pricer; paid under fee schedule or other payment system
Not paid, or not paid under OPPS
Paid at reasonable cost
Paid standard amount for pass-through drug or biological
Payment based on charge adjusted to cost
Additional payment for new drug or new biological
Paid partial hospitalization per diem
No additional payment; payment included in line items with APCs
Paid FQHC encounter payment
Not paid or not included under FQHC encounter payment
No additional payment, included in payment for FQHC encounter
Paid FQHC encounter payment for new patient or IPPE/AWV
Grandfathered tribal FQHC encounter payment
FQHC IOP encounter payment
Wrap-around payment for FQHCs that contract with Medicare Advantage (MA) organizations
Unknown Value
8 | IOCE_DISC_FLAG_C_NAME | VARCHAR | No |
IOCE discount flag.
May contain organization-specific values: No
Category Entries:
1.0
(1.0 + D(U-1))/U
T/U
(1 + D)/U
D
TD/U (Discontinued 1/1/2008, v9.0)
D(1 + D)/U (Discontinued 1/1/2008, v9.0)
2.0
2D
Unknown Value
9 | IOCE_DENY_REJECT_C_NAME | VARCHAR | No |
IOCE Deny or Reject flag.
May contain organization-specific values: No
Category Entries:
Line item not denied or rejected
Line item denied or rejected
The line is not denied or rejected, but occurs on a day that has been denied or rejected
Line item not denied or rejected; identified for informational alert only
Unknown Value
10 | IOCE_PAYMENT_ADJ_FLAG_C_NAME | VARCHAR | No |
IOCE payment adjustment flag returned from IOCE. The released values are extracted from CMS code and ultimately owned by CMS.
May contain organization-specific values: No
Category Entries:
No payment adjustment
Paid standard amount for pass-through drug or biological
Payment based on charge adjusted to cost
Deductible not applicable (specific list of HCPCS codes)
Blood/blood product used in blood deductible calculation
Blood processing/storage not subject to blood deductible
Deductible/coinsurance not applicable
Coinsurance not applicable
Multiple service units reduced to one by OCE processing; payment based on single payment rate
Offset for first device pass-through
Offset for second device pass-through
PAMA Section 218 reduction on CT scan
Reserved for future use
Terminated procedure with pass-through device
Condition for device credit present
Offset for first pass-through drug or biological
Offset for second pass-through drug or biological
Offset for third pass-through drug or biological
CAA Section 502(b) reduction on film X-ray
CAA Section 502(b) reduction on computed radiography technology
Coinsurance deductible n/a, as well as subject to a reduction due to film x-ray (CAA Section 502b)
Coinsurance deductible n/a, as well as subject to a reduction due to computed radiography technology (CAA Section 502b)
Deductible not applicable and coinsurance reduced
Payment limitation for first H1 device
Payment limitation for second H1 device
First Non-opioid Drugs and Biologicals for Post-Surgical Pain Relief
Second Non-opioid Drugs and Biologicals for Post-Surgical Pain Relief
Third Non-opioid Drugs and Biologicals for Post-Surgical Pain Relief
Unknown Value