Beginning August 1, 2025, NextBlue will be implementing the following clinical and claims edits below, to ensure Medicare Advantage claims are aligned with Centers for Medicare & Medicaid Services (CMS) billing guidelines.
- Duplicate claims
- Incorrect discharge status for transfers to home health
- Type of Bill (TOB) 131 submitted twice for separate services
- Home Health Consolidated Billing Violations
- Services billed within the three-day payment window prior to an inpatient admission
- Outpatient services billed during an inpatient stay
Please visit the latest new section Provider News | NextBlue of North Dakota to read the entire article.
Questions?
Contact our NextBlue Provider Service Center at 844-753-8039.
