Introduction • NCCI

The federal Patient Protection and Affordable Care Act, passed into law earlier this year mandates that effective for claims filed on or after October 1, 2010, State Medicaid Agencies must incorporate and apply editing methodologies of the National Correct Coding Initiative (NCCI).

The Centers for Medicare and Medicaid Services (CMS) has been charged by Congress with the responsibility for defining the adjudication rules, and provider types and claim types that will be subject to the NCCI edits. On September 1, 2010, CMS will issue these directions to State Medicaid agencies.

Alaska Medicaid, like all other State Medicaid agencies, will be required to enforce these edits within the claims processing environment. Two types of edits are mandated in the law: procedure-to-procedure and unit of service. The types of claims subject to these types of edits and the scope of these edits will not be known until further information is received from CMS. The potential exists that these edits could impact your claims filed on or after October 1, 2010.