MedicaidBilling CodesHigh impact
Provider Letter 2021-12: National Correct Coding Initiative Program
Oklahoma SoonerCare·OK·Coding
Effective date
Oct 1, 2021
We identified it
Jun 20, 2026
Summary
Oklahoma Medicaid will begin implementing National Correct Coding Initiative (NCCI) edits including Procedure to Procedure (PTP) and Medically Unlikely Edits (MUE) effective October 1, 2021. This will affect professional services, DME claims, and later outpatient facility claims, potentially causing claim denials for improper coding combinations.
Action Required
By October 1, 2021: Billing team must review current coding practices against NCCI edits to identify potential PTP edit conflicts and MUE violations. Update billing software to flag common NCCI edit combinations. Train coders on NCCI methodologies using CMS resources at medicaid.gov/medicaid/program-integrity/ncci/. Monitor initial claim denials closely after implementation and adjust coding workflows. Contact OHCA Provider Helpline at 800-522-0114 for specific edit questions.