Changes to Correct Coding Initiative (CCI) and Outpatient Code Editor (OCE) Edits for Claims Processing

As a reminder, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) generally aligns with the Centers for Medicare & Medicaid Services (CMS) on Correct Coding Initiative (CCI) and Outpatient Code Editor (OCE) edits when processing claims. Effective July 28, 2021, Blue Cross NC will fully adopt all CCI and OCE edits which will promote consistent and correct coding methodologies.

In the past, there may have been variances applied or exceptions made to these coding methodologies however, moving forward, Blue Cross NC will apply standard CCI and OCE edits.

Changes will be stated in the OCE Edits and bundling guidelines reimbursement policies.

These changes apply to the following lines of business: Administrative Services Only (ASO), fully insured membership, IPP Host and the State Health Plan (SHP).

For additional medical policy notifications, please visit our Medical Policy Updates page.