Procedures for Paying Claims Without Passing through the

40.4.2 - Procedures for Paying Claims Without Passing through the 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.