Action to Correct the Impact of Certain National Correct Coding Initiative (NCCI) Edits, CR 106771

Maine Department of Health & Human Services sent this bulletin at 12/30/2021 05:33 PM EST

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Action to Correct the Impact of Certain National Correct Coding Initiative (NCCI) Edits, CR 106771

This message is for providers of MaineCare Benefits Manual (MBM) Section 31, Federally Qualified Health Center (FQHC) services and Section 103, Rural Health Clinic (RHC) services.

Please be aware of the following changes regarding recent claim denials related to NCCI Procedure to Procedure (PTP) edits:

Effective October 1, 2021, OMS has updated the edit that is currently denying the T1015 service from “deny” to “warn,” which will allow claims to process. If you have claims that have previously denied due to NCCI PTP edits, the Office of MaineCare Services (OMS) will reprocess your claims. No provider action is needed.
In the coming months, OMS will implement a system change, in accordance with federal guidance, to opt out of applying PTP NCCI edits to claims for FQHCs and RHCs. OMS will provide notice and additional guidance when the system change is fully implemented.

Please contact your Provider Relations Specialist, Tia Bolduc, with any questions.

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