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Humana, Aenta and Cigna Adopt NCCI Changes

23 Feb 2021 2:55 PM | Zachary Edgar (Administrator)

Visit our NCCI page for all therapy edits.

CMS published new edit files effective Jan. 1, 2021, and made the edit deletions retroactively effective to Jan. 1, 2020. Humana’s policy is consistent with the CMS changes.

The Humana decision significantly reduces the instances in which a PT will need to append the 59, X, XE, XP, XS, or XU modifiers and will eliminate situations in which certain code pairs were prohibited. The change is anticipated to have a positive impact on the provision of necessary care and reduce administrative burden associated with claim denials and appeals.

According to Humana, it will reprocess claims that were denied based on the edits dating back to Jan. 1, 2020, if a provider resubmits the claim.

Each insurer is approaching the shift in different ways when it comes to how claims will be processed:

  • CIGNA will not retroactively process claims but will acknowledge the NCCI edits deletions starting Jan. 1, 2021.
  • Aetna will retroactively reprocess claims to Jan 1, 2020. Providers do not need to resubmit their claims; instead, Aetna will auto-process the claims. The insurer says this could take several months.
  • Humana will retroactively reprocess claims to Jan. 2, 2020; however, unlike Aetna, providers must resubmit claims.


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