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Does BCBS insurance follows Medicare NCCI edits


Yes, BCBS follows Medicare NCCI edits and the same has been incorporated into BCBS editing system. BCBS considers CMS NCCI edits are a recognized industry source for relationships between codes. All BCBS code editing systems will be incorporated with Medicare NCCI edits but the implementation dates differs between the states. For example Effective October 23, 2008, all Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) edits has been incorporated into Blue Cross Blue Shield of Florida’s (BCBSF) code editing system whereas Blue cross of Alabama began using National Correct Coding Initiative edits effective October 1, 2010.

BCBS will use the “Column One/Column Two” NCCI edits to determine whether CPT and/or HCPCS codes reported together by the same physician for the same member on the same date of service are eligible for separate reimbursement. There are specific modifiers that may be appended to CMS’ NCCI Columns 1 and 2 edits and Mutually Exclusive edits as well as BCBS edits when appropriate.

References:

www.bcbsfl.com/DocumentLibrary/Providers/Content/227095.pdf

https://www.bcbsal.org/providers/newpaymentmethodology/modifiers.pdf

https://www.excellusbcbs.com/wps/wcm/connect/b75fc7804533079db35cfbef58edd5a7/Jan11ConnectionFinalWeb.pdf?MOD=AJPERES

http://www.bcbst.com/providers/bluecare-tenncareselect/

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