Skip to Main Content

On Feb. 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. To learn more about this from Change Healthcare, please click here or reach out to the contact center at 1-866-262-5342.

LEAs and Respective Billing Agencies – Changes to NCCI MUE Edits (IB 24-10)

Date: 04/25/24

Louisiana Healthcare Connections is sharing with providers a publication for LEAs and Respective Billing Agencies about changes to NCCI MUE edits. Providers are encouraged to read the entire IB for any additional information.

Effective January 16, 2024, Louisiana Medicaid no longer applies the National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUE) to claims submitted by Provider Type (PT) 70 (LEA = Licensed Educational Agency) containing Healthcare Common Procedure Coding System (HCPCS) codes representing services provided by non-practitioners. This change is in accordance with Section 5.5 of the Medicaid National Correct Coding Initiative Technical Guidance Manual: 

“5.5 Additional Types of Providers Whose Claims May Be Subjected to Application of the Medicaid NCCI Methodologies  State Medicaid agencies have the option to use the Medicaid NCCI methodologies in reimbursing applicable Medicaid claims from other types of providers of outpatient services.

States do not have to request CMS approval to not apply the Medicaid NCCI methodologies to Medicaid claims from these types of providers. These optional types of providers include, but are not limited to, the following: 

  • Physician office-based laboratories, independent clinical laboratories, independent radiology facilities, and independent diagnostic testing facilities. 
  • Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Community Mental Health Centers (CMHCs), comprehensive outpatient rehabilitation facilities, free-standing dialysis centers, chemical dependency treatment centers, independent ambulance companies, and providers of outpatient services in homes, schools, hospices, and nursing homes which are not practitioners.” 

Claims containing HCPCS codes submitted by PT 70 performed by non-practitioners that have denied with Explanation of Benefits (EOB) 809 (CCI: Units of service exceeds medically unlikely edit) will be recycled for payment retroactive to March 28, 2023 with no action required by providers. (March 28, 2023, signifies the implementation of the ClaimsXTen editing software, which is when these services began editing via NCCI MUE.)

Other services submitted by PT 70 provided by physician/practitioners will continue to be edited by NCCI MUE edits.

Providers with questions regarding Medicaid Fee-for-Service claims should contact Gainwell Technologies at (800) 473-2783 or (225) 924-5040.