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 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