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Wiki Are NCCI edits date of service driven?

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mmaldo

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A provider bills a procedure code for DOS 12/01/10. It is sent for payment to the insurance company where it is received within timely filing limits but is going to be processed for payment 01/05/11. Now that it is past 01/01/11 the new NCCI edits have been published and that code is now considered bundled and has a modifier indicator of "0". The insurance company has denied this code now.

My question is since the DOS was 12/01/10 before the new NCCI edits were published should the provider be compensated accoring to the DOS? Or would payment be denied because at the time the claim was processed for the actual payment NCCI edits were already published.

Thanks again :)
Megan
 
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