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As previously communicated, AmeriHealth is making
system and process changes that will affect the way we
do business with you. As a result, there will be a change
to the processing of claim service units for professional
claims for AmeriHealth Pennsylvania members, effective
November 1, 2013. Medically Unlikely Edits (MUE) will
now be applied to professional claims, in addition to
facility claims.
AmeriHealth claims will continue to be adjudicated
using the Centers for Medicare & Medicaid Services
(CMS) MUEs for facility claims as referenced in Bulletin
#08-2010: Fee Schedule Update and Reminders for Billing
Outpatient Units of Service and ER Follow-Up Care.
An MUE is assigned to certain HCPCS/CPT? codes
identifying the maximum units of service a provider
performs on a patient on a given date of service.
Note: Claim lines with billed units that exceed
CMS-published MUE values will be rejected. Claims
reported with ICD-9 procedure codes are not affected.
For a complete listing of CMS-published MUE
values, go to www.cms.gov/Medicare/Coding/
NationalCorrectCodInitEd/MUE.html.
For more information about our Upcoming System and
Process Changes, please visit our dedicated site.
]