NCCI Error on Institutional Claims

Blue Cross Blue Shield of North Dakota (BCBSND) has identified a National Correct Coding Initiative (NCCI) system error for UB-04 claims. Currently, the claims processing system is not rejecting all lines for NCCI which has resulted in some lines paying in error. Once the system is corrected, a recovery will be completed to offset any services paid in error.

Due to this issue, a high volume of claim corrections and appeals have been submitted to append modifiers to claim lines rejected due to NCCI Guidelines.

When adding a modifier to a rejected line, this may cause additional claim rejections or denials on subsequent claim lines based on NCCI Guidelines. Providers are encouraged to review each date of service (DOS) and the respective procedure codes for the DOS on the entire claim when making corrections or submitting appeals. This will assist providers to ensure all lines on the claim are submitted correctly and to avoid additional claim line denials.

Providers should refer to the Correct Coding Guidelines Reimbursement Policy for more information.

HealthCare News Blast | September 25, 2019