What is ClaimsXten Select, and why have the 1199SEIU Benefit Funds implemented this software?
Whom does this affect?
How will this affect reimbursement?
What do NCCI policies and guidelines entail?
- NCCI Procedure-to-Procedure Edits prevent inappropriate payment of services that should not be reported together. If a provider reports the two codes of an edit pair for the same member on the same date of service, the column one code is eligible for payment, but the column two code is denied, unless a clinically appropriate NCCI associated modifier is also reported.
- Medically Unlikely Edits (MUEs) prevent payment for an inappropriate number/quantity of the same service on a single day. An MUE for an HCPCS/CPT code is the maximum number of units of service under most circumstances reportable by the same provider for the same member on the same date of service.
- Add-on Code Edits consist of a listing of HCPCS and CPT add-on codes with their respective primary codes. An add-on code is eligible for payment if, and only if, one of its primary codes is also eligible for payment.
Will there be changes in how providers submit claims?
How will we be notified of new edits?
Will these edits read historical claims data?
How can we identify claims/claim lines that have ClaimsXten Select edits applied?
What if I disagree with how the claim was processed?
Mail: 1199SEIU Benefit Funds, Medical Claims Reconsideration, PO Box 717,
New York, NY 10108-0717
Fax: (646) 473-7088
Email: [email protected]
How can I determine if the codes I am submitting on a claim will be evaluated by ClaimsXten Select during claim adjudication, and what will be the anticipated outcome?
For additional information regarding ClaimsXten, email [email protected]. You should receive a response within 24 hours.