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TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Outpatient Prospective Payment System (OPPS)-Ambulatory Payment Classification (APC)
Chapter 13
Addendum A
Development Schedule For TRICARE Outpatient Code Editor (OCE)/Ambulatory Payment Classification (APC) Quarterly Update
Revision:  
Critical Tasks and Milestones
#
Who
Event
Days
Note:  The above quarterly time expectations are ideal, but may be subject to change.
1
OPPS OCE and PRICER Vendor
Preliminary CMS edit & logic changes to TRICARE (new edits, logic, flags, etc.)
2
DHA/Contractors
Provide TRICARE-specific edit/logic changes to OPPS OCE and PRICER Vendor
10 days
3
OPPS OCE and PRICER Vendor
CMS data changes to TRICARE (new codes, APC, SI) Plus Intersection Report
4
DHA/Contractors
Provide TRICARE-specific data changes to OPPS OCE and PRICER Vendor (APC, SI, edit assignment, …) (see Addendum B)
10 days
5
OPPS OCE and PRICER Vendor
Update TC Working specifications
3 days
6
OPPS OCE and PRICER Vendor
Write code for TRICARE program logic/edit and product changes: (Component, MF)
5 days
7
OPPS OCE and PRICER Vendor
Update TC mods files & Build TC Read-Only Tables (ROTs)
6 days
8
OPPS OCE and PRICER Vendor
TRICARE Working specs & Data Summary to TRICARE - For Review/Approval
5 days
9
OPPS OCE and PRICER Vendor
Unit test TC program & product changes - Component, MF (need ROT from Step 7)
1 day
10
OPPS OCE and PRICER Vendor
Build TC ROT #2 … If necessary.
(To correct errors or make late CMS changes)
3 days
11
OPPS OCE and PRICER Vendor
Create User Documentation
12 days
12
OPPS OCE and PRICER Vendor
Test case creation
Alpha testing
Install testing
7 days
8 days
2 days
13
OPPS OCE and PRICER Vendor
Media and Documents production
1 day
14
OPPS OCE and PRICER Vendor
Release - General Release to TRICARE and Contractors
- END -

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