Effective April 1, 2011, all fee-for-service Medicaid plans must adopt and incorporate
National Correct Coding Initiative (NCCI) edits as part of a federal mandate. These edits, although similar to ClaimCheck, will be used in conjunction with Medicaid’s current claims edit system.
In early 2011, the Centers for Medicare and Medicaid Services required all states to submit a planning document outlining what NCCI edits would affect their current Medicaid benefit plan so that those edits could be deactivated.
This
list shows NCCI edits applicable to physicians. To view codes for a particular service type, click the appropriate link in the list.
NCCI edits were developed to prevent improper payment when incorrect code combinations are reported. There are two types of NCCI edits:
- Procedure-procedure edits: Defines codes that should not be reported together for a variety of reasons.
- Medically unlikely edits/units-of service edits: Defines the number of units payable for certain codes.