How are NCCI edits going to affect claims processing and payment?
In the Medi-Cal processing system, claims will process for NCCI edits before being processed for Medi-Cal edits. NCCI Procedure to Procedure and MUE edits are applied to services performed by the same provider for the same recipient on the same date of service. A Treatment Authorization Request (TAR) may be allowed to override an NCCI Medically Unlikely Edit. That is, where medical justification is currently allowed to override a Medi-Cal edit, this justification may be considered for a quantity greater than that allowed by the MUE. Procedure to Procedure edits are applied to all services with the same date of service whether the services are submitted on the same or different claims. MUE edits are applied separately to each line of a claim.
