National Correct Coding Initiative (NCCI) Outpatient and Physician Edits Now Applied to Initial Claims

Two National Correct Coding Initiative (NCCI) edits that apply to initial Outpatient and Professional claims will be activated in NCTracks on June 7, 2015, to claims submitted as electronic X12 837 transactions.  Claims that fail the edits will have EOBs 49270 – NCCI PHYSICIAN EDIT or 49280 – NCCI OUTPATIENT HOSPITAL SERVICES EDIT posted to their NCTracks paper Remittance Advice (RA).  The same edits are already in place and therefore have already been applied in the ordinary course for adjustment/replacement claims and claims submitted through the NCTracks Provider Portal, but were not applied to initial claims submitted as electronic X12 837 transactions. Therefore, applicable electronic X12 837 claims paid since July 1, 2013, will be reprocessed to apply these edits and adjust the claim accordingly. No date has been set for the claim reprocessing.