Optum Type of Bill I/OCE Edit OPPS API

openapi: 3.2.0
info:
  title: CMS Common Facility Type of Bill I/OCE Edit OPPS API
  description: MicroService that contains CMS related information
  contact:
    name: Ken Kracker
    email: ken.kracker@optum.com
  version: v1.0
servers:
- url: /v1/cmscommonms
tags:
- name: Type of Bill I/OCE Edit OPPS
paths:
  /api/cms/facility/tob-oce:
    get:
      tags:
      - Type of Bill I/OCE Edit OPPS
      summary: Fetches the type of bill I/OCE edit
      operationId: getTobOce
      parameters:
      - name: limit
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 250
      - name: page
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 1
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: Fetch the type of bill I/OCE Edit OPPS details
          content:
            application/json:
              example:
                content:
                - code: '1'
                  description: TOB 012X or 014X with condition code 41 reported in FLs 18-28
                - code: '2'
                  description: TOB 012X or 014X without condition code 41
                totalCount: 19
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2024-04-24T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/facility/tob-oce
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
  /api/cms/facility/tob-oce/{code}:
    get:
      tags:
      - Type of Bill I/OCE Edit OPPS
      summary: Fetches the specifics bill type of bill I/OCE edit
      operationId: getTobOceByCode
      parameters:
      - name: code
        in: path
        description: Code of the TOB OCE
        required: true
        schema:
          type: string
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: Fetch the type of bill I/OCE edit OPPS details
          content:
            application/json:
              example:
              - description: Line Item Date Edit
                oceValueList:
                - code: '10'
                  description: Service submitted for denial (condition code [UB-4 FL 18-28] 21)
                  editResult: "This edit occurs when the claim has a condition code 21, Request for Denial Notification, reported  in FLs 18-28.    It identifies services that are billed by a provider for a denial notice. \n\nThe claim will be denied."
                  providerAction: 'The provider cannot correct and resubmit the claim but they can appeal the denial.  '
                - code: '23'
                  description: Invalid date
                  editResult: "This edit occurs when the from and through statement covers dates (FL 6) or the service date (FL 45) are invalid or the service date falls outside the from and through dates.  This edit terminates the processing of the claim. \n\nReturn claim to provider (RTP)."
                  providerAction: The provider should resubmit the claim once the problem(s) is/are corrected.
                - code: '24'
                  description: Date out of OCE range
                  editResult: "This edit occurs when the \"from\" date reported in the statement covers period, FL 6 falls outside the date range for any version of the OCE program (before August 1, 2000).  This edit terminates the processing of the claim.  \n\nThe claim will be suspended."
                  providerAction: A suspended claim is not returned to the provider but will not be processed for payment until the FI makes a determination or obtains further information.
                - code: '11'
                  description: Service submitted for FI/MAC review (condition code [UB-4 FL 18-28] 20)
                  editResult: 'This edit occurs when the claim has a condition code 20, Request for FI/MAC Review,  reported  in FLs 18-28.  It identifies non-covered services that are billed by the provider when a beneficiary requests a Medicare review for coverage.


                    The claim will be suspended.'
                  providerAction: A suspended claim is not returned to the provider but will not be processed for payment until the FI makes a determination or obtains further information.
              - description: Bill Type Edit
                oceValueList:
                - code: '46'
                  description: Partial hospitalization condition code 41 not approved for type of bill
                  editResult: "This edit identifies incorrect partial hospitalization claims and occurs when TOB code (FL 4) 12X or 14X is present on the claim with condition code 41 in FLs 18-28. \n\nReturn claim to provider (RTP)."
                  providerAction: The provider should resubmit the claim once the problem(s) is/are corrected.
        '400':
          description: 'Bad request: If any of the path parameters are invalid'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                error:
                - Type of Bill I/OCE Edit Code is not supported
                warning: null
                info: null
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2024-04-24T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/facility/tob-oce/111
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
components:
  schemas:
    Notification:
      type: object
      properties:
        error:
          type: array
          items:
            type: string
        warning:
          type: array
          items:
            type: string
        info:
          type: array
          items:
            type: string
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
x-readme:
  explorer-enabled: true
  proxy-enabled: true