NCCI Methodologies for Medicaid

Beginning with claims submitted on October 1, 2010, PPACA requires states to add to their MMISs pre-payment edits to correct and control improper coding, similar to the NCCI edits used by Medicare contractors. By September 1, 2010, the Secretary is required to

(1) identify NCCI methodologies compatible with Medicaid claims, and

(2) identify methodologies applicable to Medicaid, but for which no Medicare NCCI methodologies had been established. 

The Secretary is  also required to notify states of NCCI methodologies applicable to Medicaid that were identified and outline how states are to incorporate those methodologies into their Medicaid claims processing systems.  The Secretary is required to submit a report to Congress by March 1, 2011 that includes the notice to states about the NCCI methodologies, and an analysis that supports the identification of NCCI methodologies to be applied to Medicaid claims.