Guides
Billing and denials, explained plainly
Evergreen guidance on NCCI edits, medically unlikely edits and reading a remittance, for working medical billers. Where a claim depends on the specific code pair or payer, we link the cited lookup page rather than stating a number that might not be yours.
Reading a remittance: turning a CARC and RARC pair into a corrective action
A remittance advice gives you a CARC and usually one or more RARCs. Here is what each one is actually telling you, how the group code decides who owes the money, and how to turn the pair into a ranked next step instead of a guess.
Read the guideMUE MAI 1 vs 2 vs 3: which unit-count denials you can actually appeal
A medically unlikely edit denial is not one thing. The adjudication indicator, MAI 1, 2 or 3, decides whether reducing units, resubmitting with documentation or appealing is even possible. Getting this wrong wastes an appeal on a code that can never win one.
How NCCI PTP modifier indicators work, and when modifier 59 is actually legitimate
NCCI procedure-to-procedure edits carry a modifier indicator of 0, 1 or 9. Only indicator 1 can ever be bypassed by a modifier, and only when the two services were genuinely distinct. Here is how the check actually works.
A guide explains the mechanism. Your remittance decides the code.
Look up the exact CARC, RARC or modifier on your claim, cited to the X12 or CMS source, or scrub the claim before you send it.