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Correct Coding Initiative

The National Correct Coding Initiative (NCCI) is a Centers for Medicaid and Medicare Services (CMS) program. It was developed to promote the national correct coding methodologies and to control improper coding leading to inappropriate payment in Medicare. It is based on coding conventions from a variety of sources, such as the American Medical Association (AMA) Current Procedural Terminology (CPT) Guidelines, national professional association’s recommendations, and common coding practices.

Healthcare legislation H.R. 3962 requires that Medicaid programs incorporate compatible methodologies of the NCCI into their claims processing system, effective for claims filed on or after October 1, 2010.

MHS would like to help you perform under the NCCI standards. MHS utilizes HealthCare Insight (hcinsight.com) for NCCI reviews during claims processing.

If a claim is denied with a request for medical records, please forward the records promptly to support that billing so you can receive reimbursement. If you receive a different coding denial, please follow the MHS Claims Appeal process, outlined in chapter # 5 of the MHS Provider Manual.

State and Federal Resources

CMS.gov National Correct Coding Initiative Edits Website

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