Enhanced outpatient facility editing for National Correct Coding Initiative: Medically Unlikely Edits (MUEs) 

Beginning with claims processed on and after November 15, 2023, we will update our claims editing process for outpatient facility claims by applying the Medicare National Correct Coding Initiative (NCCI) Medically Unlikely Edits. NCCI edits are Centers for Medicare & Medicaid Services (CMS) developed guidelines to promote national correct coding based on industry standards for current coding practices.

These edits provide an opportunity to shift certain existing back-end reviews to front-end adjudication for outpatient facility claims. While this may facilitate quicker claim adjudication, it may also cause claims to deny frequency unit limits tied to Medically Unlikely Edits (MUEs) if correct coding guidelines are not followed. For additional information, please visit CMS.gov and select the Medically Unlikely Edits page.

If you have questions about this communication or need assistance with any other item, contact your Provider Relationship Management representative.