The Centers for Medicare and Medicaid Services (CMS) expects state Medicaid programs to follow the rules of the National Correct Coding Initiative (NCCI). CMS created the NCCI in 1996. NCCI promotes correct coding practices nationwide and controls incorrect coding, which can lead to incorrect payments for Medicaid claims.
Coding policies are made based on rules found within the following tools:
CMS reviews and updates these policies yearly to ensure all NCCI coding practices match Medicaid claims.
The CMS website contains the following:
Compliance checks take place to evaluate claims against the NCCI edits both before and after payment. Reviewing pre-payment editing may result in claim denial; reviewing post-payment editing may result in a refund request.
CMS instructs states to use NCCI edits first. Edits from each state are then applied to the claims. Payment of a claim is dependent on compliance with all NCCI and Nebraska-specific edits.
Most Nebraska Medicaid claims are compatible with CMS standards. Nebraska Medicaid will post changes and helpful tools as they become available.
Nebraska Implementation of the National Correct Coding InitiativeFrequently Asked Questions (updated 11/20/2017)
NCCI Provider Information