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IOCE Bypass Configuration

The Contractor Bypass feature allows users to create configurations that bypass the regular functioning of the IOCE editor. This provides a means for overriding edits or other payment flag values.

Overview

The Contractor Bypass functionality includes individual input entries for edit and payment flags to bypass IOCE edits and any applicable payment flag value which may need adjustment for final payment determination.

Creating a Bypass Configuration

To create a new bypass configuration: 1. Navigate to the Customizations → IOCE Bypass Config section in the dashboard. 2. Click Create Configuration. 3. Fill in the configuration details: * Label: A descriptive name for the configuration (e.g., "Q1 2025 Special Rules"). * Description: Optional details about the purpose of this bypass. * Effective Date: The start date when this configuration becomes active. * Termination Date: Optional end date. Leave blank for open-ended configurations. * Claim-Level Edit Bypass Codes: Comma-separated list of IOCE edit codes to bypass at the claim level (e.g., 1, 2, 5). * Status: Toggle to Active to enable the configuration immediately.

Configuring Bypass Lines

Once a configuration is created, you can add specific line-level overrides. These overrides apply to specific HCPCS codes and modifiers.

Available Fields

The following fields are available for Contractor Bypass on each line:

  1. Edit Bypass List: A list of edits to bypass specific IOCE checks for this line.
  2. Payment APC: Override the Ambulatory Payment Classification assignment.
  3. Status Indicator: Override the status indicator (e.g., S, T, N).
  4. Payment Indicator: Override the payment indicator.
  5. Discounting Formula: Specify a discounting formula number (e.g., 1, 8).
  6. Line Item Denial or Rejection Flag: Flag to indicate denial or rejection (Y/N).
  7. Packaging Flag: Override packaging status.
  8. Payment Adjustment Flag 1: First payment adjustment override.
  9. Payment Adjustment Flag 2: Second payment adjustment override.
  10. Payment Method Flag: Override the payment method.

How it Works

  • Line Level: The presence of an IOCE edit in the Contractor Bypass edit field allows the bypass to execute for the impacted line. A line-level edit bypass does not require all fields to be provided; only fields that require changes need to be entered.
  • Claim Level: A claim-level edit bypass requires only the Contractor Bypass edit field (in the Configuration settings) to be populated. This can be used to override edits not associated with a specific HCPCS code, such as an invalid diagnosis code.

Bulk Import/Export

You can manage large sets of bypass rules using CSV files: * Export: Download the current configuration lines to CSV for editing or backup. * Import: Upload a CSV file to bulk add or replace lines in a configuration. A template is provided in the import dialog.