Medically Unlikely Edits: Some Claims Denied in Error

Recent updates made to Medically Unlikely Edits (MUEs) caused some claims to deny in error with remark code CO-151. These claims were processed from 3/26/2014 to 4/4/2014, and many (but not all) of the affected claims are for hospital visits. The problem has now been corrected, and claims processed after that time are being processed correctly. CGS has identified the claims that may have denied in error and will be automatically adjusting these claims beginning the week of 4/21/2014. Please take into consideration the payment floor when reviewing your remits to determine any impact to your organization. No action is needed on the part of providers to correct these claims.