Commonwealth Care Alliance (CCA) is continuing the application of the Medicare National Correct Coding Initiative (NCCI). As you may recall, in 2018, CCA began a staged process of applying NCCI edits.
On June 1, 2023, CCA implemented NCCI Medically Unlikely Edits (MUEs) for Senior Care Options and One Care products. NCCI MUEs are utilized by Medicare Administrative Contractors (MACs) to reduce improper payments for Part B claims. For more information, please refer to the CMS website at cms.gov/medicare-medicaid-coordination/national-correct-coding-initiative-ncci/ncci-medicare/medicare-ncci-medically-unlikely-edits or refer to CCA’s General Coding payment policy on the CCA website at commonwealthcarealliance.org/ma/providers/medical-policies/cca-payment-policies/.