Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Medically Unlikely Edits now applied to professional and facility claims

December 2, 2013

[

As previously communicated, IBC is in the process of transitioning to a new claims processing platform that will offer greater capabilities. As a result of this transition, there was a change to the processing of claim service units for professional claims, effective November 1, 2013. Medically Unlikely Edits (MUE) are now applied to professional claims, in addition to facility claims.

Claims processed on the new platform will continue to be adjudicated using the Centers for Medicare & Medicaid Services? (CMS) MUEs for facility claims, as referenced in Bulletin #08-2010: Fee Schedule Update and Reminders for Billing Outpatient Units of Service and ER Follow-Up Care.

An MUE is assigned to certain HCPCS/CPT? codes identifying the maximum units of service a provider performs on a patient on a given date of service.

Note: Claim lines with billed units that exceed CMS-published MUE values will be rejected. Claims reported with ICD-9 procedure codes are not affected.

For a complete listing of CMS-published MUE values, go to www.cms.gov/Medicare/Coding/ NationalCorrectCodInitEd/MUE.html.

For more information about our Business Transformation, please visit our dedicated site. On this site, you will find a communication archive and Frequently Asked Questions (FAQ) document. If you still have questions after reviewing the FAQ, email us.

]

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.