In the past, state Medicaid programs could choose to use the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) edits, develop and use their own edits, use proprietary coding edit systems, or use a combination of all of these. As reported in the December 2010 issue of the AAP Pediatric Coding Newsletter™, the Patient Protection and Affordable Care Act of 2010 mandates that state Medicaid programs use CMS NCCI edits. Medicaid agencies should have incorporated CMS NCCI edits into their claim systems effective for claims filed on and after October 1, 2010.

In September 2010, the CMS notified Medicaid programs of

The CMS had until March 1, 2010, to submit a report to Congress that included the notices sent to state Medicaid programs and with an analysis supporting these methodologies. (All letters sent to state Medicaid programs can be found at www.cms.gov/SMDL/SMD/list.asp.)

Prior to...

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