Ambulatory Payment Classification (APC) Updates For Providers

Date: 08/14/26

Oklahoma Complete Health processes claims according to Oklahoma Health Care Authority (OHCA) guidelines. 

For outpatient hospital claims paid under the Ambulatory Payment Classification (APC) methodology, reimbursement is based on the APC fee schedule that is effective for the date of service. 

Effective January 1, 2017, OHCA implemented the J1 Status Indicator. When a claim includes multiple procedures with a J1 status indicator, only the highest-paying J1 procedure is reimbursed. The remaining J1 procedures are considered bundled into that service and are reimbursed at $0.00 in accordance with APC payment rules. If a service does not have reimbursement under the APC fee schedule, Oklahoma Complete Health will review the claim to determine whether payment is available under a flat-rate reimbursement methodology. Under this methodology, the eligible service with the highest reimbursement amount is paid, and additional services of the same type are bundled and reimbursed at $0.00. If neither APC nor flat-rate reimbursement applies, certain services may qualify for reimbursement under the applicable Title XIX fee schedule. Providers participating in the 340B carve-in program should note that claims billed with the appropriate 340B modifier are processed according to OHCA's 340B reimbursement guidelines and methodology.  

For additional information, please refer to the following resources: 

• OHCA APC Payment Guidance 
• OHCA J1 Reimbursement Information 
• OHCA Outpatient Hospital Reimbursement 
• OHCA 340B Drug Discount Program