CCHP follows the National Correct Coding Initiative (NCCI) which was created by the Centers for Medicare and Medicaid. This initiative was created to stop improper coding which leads to incorrect payments.
Forward Health has implemented the NCCI to monitor all professional claims and outpatient hospital claims submitted with Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) for compliance with:
MUE (Medically Unlikely Edits), or units-of-service detail edits.
Procedure-to-Procedure detail edits.
MUE is the maximum units of service that a provider would claim for a single member on a single date of service for each code. Procedure-to-Procedure detail edits define pairs of codes that should not be claimed together on the same date of service.
If the claim is denied for either of these reasons, providers will receive an explanation of benefits on the remittance advice that it was denied because of NCCI.
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