MedicaidAdministrativeHigh impact
Provider Letter 2021-15: National Correct Coding Initiative Program
Oklahoma SoonerCare·OK·Coding
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
OHCA (Oklahoma Medicaid) is implementing National Correct Coding Initiative (NCCI) editing for professional and DME claims starting January 1, 2022. The policy emphasizes correct usage of modifiers 25 and 59, as testing revealed providers are not using these modifiers appropriately.
Action Required
By January 1, 2022: All providers must ensure correct usage of modifier 25 (for significant, separately identifiable E/M services on same day as procedures) and modifier 59 (for distinct non-E/M services performed same day). Billing team must review NCCI manuals at medicaid.gov and attend December 2021 webinars (registration via global messages). Update billing practices to comply with NCCI editing rules to prevent claim denials.