Medically Unlikely Edits for Outpatient Claims

Blue Cross Blue Shield of North Dakota (BCBSND) will apply Medicare Medically Unlikely Edits (MUE) for outpatient claims effective April 1, 2022. Outpatient claims processed under Enhanced Ambulatory Patient Group (EAPG) System will apply MUE edits with a DOS on or after April 1st, 2022. For claims processed on the Hospital Outpatient Fee Schedule (non EAPG) will apply MUE edits on claims processed on or after April 1st, 2022. 

Note: Effective April 1st, 2022, codes billed over the MUE values will result in the rejection of the entire claim line.