Who primarily uses NCCI edits?

NCCI edits, or National Correct Coding Initiative edits, are primarily utilized by healthcare coders and billing specialists in the medical coding and billing process. NCCI edits are a collection of codes that are bundled together based on provider pairing and reasoning to prevent improper coding and billing. They are implemented to ensure that codes used for submitting healthcare claims are accurate and compliant with Medicare and Medicaid guidelines.

Coders and billing specialists rely on these edits to understand what combinations of services can be billed together under a claim, ensuring that they adhere to established coding practices and avoid denials from insurance companies. By utilizing NCCI edits, they are able to improve accuracy in billing, reduce the likelihood of audits, and ensure compliance with payer rules, thus streamlining the revenue cycle for healthcare providers.

While insurance companies and payers do use these edits to process claims, the main focus of NCCI edits is on the expertise of coders and billing specialists, who interpret and apply them correctly in billing submissions.