Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth

MassHealth
School-Based Medicaid Bulletin 21

January 2012



	TO:	School-Based Medicaid Providers Participating in MassHealth

	FROM:	Julian J. Harris, M.D., Medicaid Director

	RE:	Medicaid National Correct Coding Initiative (NCCI) for School-Based Medicaid Providers


Background

Section 6507 of the federal Affordable Care Act (Public Laws 111-148 and 111-152), as implemented by the Centers for Medicare & Medicaid Services (CMS), requires state Medicaid agencies to incorporate methodologies compatible with the National Correct Coding Initiative (NCCI). This initiative, called Medicaid NCCI procedure-to-procedure code pair edits, was implemented to promote national correct coding methodologies and to control improper coding to minimize inappropriate payment.

MassHealth first implemented these NCCI edits during the implementation of 
NewMMIS in 2009. The initiative includes edits that prohibit payment in certain 
instances, for multiple services provided by the same provider to the same member on a single date of service, and for Medically Unlikely Edits (MUE) that limit payment for certain services provided in excess of set amounts.

MassHealth implemented this initiative for claims with dates of service on or after October 1, 2010, that are processed on or after April 1, 2011. In April 2011, MassHealth implemented additional NCCI edits.

Please refer to All Provider Bulletin 209 for more information on NCCI and MUEs.

Exemption for School-Based Medicaid Providers

Claims submitted by School-Based Medicaid providers have been subject to NCCI and MUE edits in the MassHealth claims system. Review of the NCCI-related guidance from CMS has determined that these edits are not required for
School-Based Medicaid providers. Effective November 30, 2011, claims submitted by School-Based providers will be exempt from these NCCI edits.

Claims that School-Based Medicaid providers submitted between April and 
November 2011, and were affected by the system’s NCCI edits, will be reconciled 
through the annual cost-reporting process.	 

Please note that this bulletin is limited to School-Based providers (provider type 89) and does not apply to hospitals or community health centers that operate school-based health centers.

Questions

If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.