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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.
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