November 2010 Newsletter
Medicaid CCI/MUE Edits
Quadax is taking the necessary steps to fulfill CMS requirements pertaining to NCCI (National Correct Coding Initiative) edits for all Medicaid claims. Because our application of these methodologies relies on the adherence of state Medicaids to the mandates, Quadax has been carefully choosing the appropriate actions to take to ensure a smooth transition.
At present, we have only just begun to receive confirmation from state Medicaids that they are ready to comply with the requirements. Because of this slow response, Quadax is taking a gradual approach to implementation in HARP by initially suppressing CCI and MUE edits for all Medicaid claims, both UB and 1500. When individual states verify that they will be following the CMS directive, the edit suppression will be lifted. MUE edits for Medicare 1500 claims are being suppressed for specific clients as well. However, CCI edits for all Medicare 1500 claims will be applied.
Quadax EDI is taking a proactive approach to the CMS policy by implementing the CCI/MUE edits in Xpeditor before receiving confirmation from state Medicaid payers; edits were activated during October for both UB and 1500 claims. EDI clients who do not want the edits applied to their Medicaid claims can create two XpressBiller Edit Suppress Rules, one for each set of edits. This will ensure that an Xpeditor Tracking record will exist to indicate that an edit was raised but bypassed by the client.
The transition to full compliance by all state Medicaids will be an ongoing process, and we will keep you informed of the progress.