US · guidance
CMS Pub. 100-04, ch. 4, § 40.4
Paying Claims Outside of the IOCE
All institutional outpatient claims are routed through the IOCE before they are processed
to payment. There may be special circumstances, however, when it is necessary to pay
claims bypassing IOCE edits. The CMS will notify the contractor of these instances.
They include:
• New coverage policies are enacted by Congress with effective dates that preclude
making the necessary changes timely; and
• Errors are discovered that cannot be corrected timely.
A/B MACs (A) are responsible for reporting problems timely.
History
(Rev. 1649; Issued: 12-18-08; Effective/Implementation Date: 11-25-08)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
187cd7c756770a43672ebcb4d076d146b9619f79b08f3c1a897c4011c01ee4d5
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