MedicaidReimbursementMedium impact
Professional and Professional Crossover Claims That Should Have Denied With NCCI Edits Have Been Reprocessed
Nevada Medicaid·NV·Billing & Coding
Effective date
Dec 4, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has automatically reprocessed and recouped payments for professional claims with incorrect NCCI code combinations that were paid in error. Claims with service dates from December 4, 2024 forward that processed between December 16, 2024 and March 10, 2025 were affected, with results appearing on May 23, 2025 remittance advice.
Action Required
Immediately: Review May 23, 2025 remittance advice for reprocessed claims and recoupments. Billing team must identify any claims that were recouped due to NCCI edits and determine if appeals are warranted. Refer to Medicaid Services Manual Chapter 100 for appeal process and timeframes if disputing any denials.