MedicaidBilling CodesHigh impact
Provider Letter 2022-05: National Correct Coding Initiative Program Outpatient Facility Claims
Oklahoma SoonerCare·OK·Coding
Effective date
May 2, 2022
We identified it
Jun 20, 2026
Summary
OHCA is implementing National Correct Coding Initiative (NCCI) editing for outpatient facility claims starting May 2, 2022, requiring proper use of modifiers 25 and 59 (XE, XP, XS, XU). Providers must ensure correct modifier usage to prevent claim denials under the new ClaimsXten processing system.
Action Required
Before May 2, 2022: Billing team must review and update coding practices to ensure proper use of modifier 25 for significant E/M services and modifier 59 (XE, XP, XS, XU) for distinct procedures performed on the same day. Train staff on NCCI modifier requirements using the Medicaid NCCI manuals at medicaid.gov. Update billing system edits and encounter forms to prompt correct modifier usage. Failure to use appropriate modifiers will result in claim denials.