HealthCare News

Medically Unlikely Edits (MUEs) – Professional Claims Only

Issue: #410 SEP2019

Topic: Reimbursement


Blue Cross Blue Shield of North Dakota (BCBSND) edits procedure code units on professional claims, through Medically Unlikely Edits (MUEs). MUEs are applied to claims based on the values posted by Centers for Medicare & Medicaid (CMS), however the Plan reserves the right to apply MUEs outside of the CMS values when it is deemed clinically appropriate. A listing of BCBSND MUEs that differ from the CMS values can be located within the Correct Coding Guidelines Reimbursement Policy.