Also linked to the 3M™ Coding and Reimbursement System, the 3M APCfinder Software for TRICARE is a grouper with similar functionality to the 3M APCfinder Software. It is designed to address TRICARE’s hospital outpatient prospective payment system (OPPS) based on ambulatory payment classifications (APCs) and on CMS’ OPPS. It incorporates the TRICARE-refined logic for the outpatient code editor (OCE) as related to APCs as well as the logic for grouping HCPCS Level I and II codes to APCs for payment purposes.

The OCE includes the National Correct Coding Initiative (NCCI) as an integral component, and other billing and clinical edits as defined by CMS and customized for TRICARE. Also included are edits defined by TRICARE for services not covered by CMS.

The 3M APCfinder Software for TRICARE also calculates reimbursement for APCs, including:

• TRICARE payments
• Pass-through payments
• Outlier payments

Payments are also calculated for other ambulatory services including items paid at cost, by national rates, and by the TRICARE fee schedules:

• CMAC (CHAMPUS Maximum Allowable Charges)
• Injectables
• DME (same as the CMS DME file)
• PEN (parenteral enteral nutrition)
• State-wide prevailing rates

APC software solutions for TRICARE fact sheet (PDF 131.7 KB)

For more information, call 800.367.2447 or click here.