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The
OCExaminer
solution provides web-based claims editing allowing hospitals to
submit their claims, validate them against OCE edits, and receive
reports detailing any rejections. We have dedicated staff to
maintain all of the edits, thereby allowing the hospital billing
staff to simply submit the claims file and get a report of any
rejected claims. All of the processing takes place on our secure
servers and is completed within hours of submission.
Companion code
edits are found in the OCExaminer
Enhanced module of the application. This
functionality greatly enhances the breadth and depth of the
OCExaminer
system, while minimally impacting claims file processing. The
following is a listing of some key companion code edits:
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143 Radiology
codes in various combinations with 488 procedure codes, resulting
in thousands of coding combinations
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60
Injection/Infusion edits for OPPS and Non-OPPS
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50 Diagnosis
codes to identify missing infusion codes
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40 Coding
combinations to identify codes that should not be billed together
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9 codes for
maximum units and ensuring that an initial/primary code exists for
any add-on codes, resulting in approximately 20 combinations
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167 I-9 procedure
codes and 204 HCPCS codes used in a variety of combinations to
identify missing carve outs and carve-out related procedures,
resulting in the following combinations:
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414 I-9 to HCPCS
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168 I-9 to
Revenue code
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and 204 HCPCS to
Revenue code
An additional
module of the OCExaminer
Enhanced system, OCExaminer
Enhanced+, allows the user to create custom edits
through user-defined fields. The purpose of this functionality is
to capture the unique elements of your managed care contracts and
ensure that payer-specific items are evaluated for coding and
billing accuracy prior to submission to the payer.
Detailed
OCExaminer Presentation (15
Minutes)
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