CMS Pub. 100-04, ch. 4, § 40.4.2

IOCE

(Rev. 4233, Issued: 02-08-19, Effective: 03-12-19, Implementation: 03-12-19)

The term Medicare beneficiary identifier (Mbi) is a general term describing a

beneficiary's Medicare identification number. For purposes of this manual, Medicare

beneficiary identifier references both the Health Insurance Claim Number (HICN) and

the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition

period and after for certain business areas that will continue to use the HICN as part of

their processes.

Before an outpatient claim may be paid without first going through the IOCE, the

contractor shall obtain approval from CMS Central Office or the RO. In all instances

involving payment outside the normal outpatient editing process, the contractor applies

the following procedures:

• Contractors shall submit the claim overriding the IOCE using the appropriate field

in FISS.

• Pay interest accrued through the date payment is made on clean claims. Do not

pay any additional interest.

• Maintain a record of payment and implement controls to be sure that incorrect

payment is not made, i.e., when the claim is paid without being subject to normal

editing.

• Monitor IOCE software to determine when the impediment to processing is

removed.

• Consider the claim processed for workload and expenditure reports when it is

paid.

• Submit to the RO Consortium Contractor Manager (CCM) by the 20th of each

month a monthly report of all outpatient claims paid without processing through

the IOCE. The list of claims paid outside of the IOCE is to include the following

information:

o Mbi

o DCN

o TOB

o DOS (From/Through)

o Provider Number

o MCE/OCE OVR (Claim/Line)

o Reimbursement Amount

o Receipt Date

o Process Date

o Paid Date

Also, include summary data for each edit code showing claim volume and payment. Any

override approvals received and/or relevant JSM references should be annotated on the

reports.