Behavioral Health NCCI Edits Activation Guidance

Date: 08/01/18

Heritage Health (Medicaid):

Effective July 1, 2018, Nebraska Total Care activated the current, standard behavioral health NCCI claim edits for Procedure to Procedure Billing and Medically Unlikely Edits.

In the event that a Behavioral Health provider receives a reimbursement denial on a claim using distinct procedural code(s) i.e. 59, or X modifier(s) for same day services, the provider may submit a claim reconsideration that includes clinical documentation to substantiate same day service for two distinct procedure codes.

Nebraska Total Care's reconsideration/appeal forms can be found on our website on the Practice Improvement Resource Center (PIRC) page.

If you have questions, please contact Provider Relations.