National Correct Coding Initiative (NCCI) Errors will now be rejected and no longer offset
Issue: #411 NOV2019
Blue Cross Blue Shield of North Dakota (BCBSND) reviews all claims for correct coding. One of the guidelines BCBSND uses for Hospital Outpatient and Professional claim(s) editing is the Centers for Medicare & Medicaid Services’ (CMS) NCCI Procedure to Procedure (PTP) files. Please note, this is used only for claims processed on the new claims platform (migrated claims) and does not apply to claims processed on the legacy claims system. CMS NCCI PTP edits apply to services billed for a member on the same date of service by the same performing provider.
Migrated claim(s) submitted prior to October 2019 were offsetting subsequent services on the same claim or subsequent claim when a NCCI PTP error was identified. BCBSND will no longer offset subsequent services containing PTP errors; all subsequent services will be rejected. Providers will need to review the CMS PTP files to determine if the code combination and documentation allow for a correction to be made by appending a valid modifier. For more information on BCBSND’s Correct Coding Policy please visit https://www.bcbsndreimbursementpolicy.com/documents/correct-coding-guidelines/.
HealthCare News Blast | October 8, 2019