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eClaims - Common Rejections - Failed MNC Edits

Failed MNC Edits
Rejection messages include, but are not limited to:

  • Failed medical necessity edits. For the related policy, HCPCS XX and ICD10 XX code combination does not support medical necessity. (Bad Data: XX )
  • CODING RELATED ERRORS PRESENT

This rejection is stating that the submitted procedure code(s) and diagnosis code(s) have not met the medical necessity requirements. MNC (Medical Necessity Checking) edits are specific edits put in place to review claims before being submitted to the payer. If the MNC edits find an issue with the submitted claim, it will be stopped for not meeting payer requirements. The rejection message will likely notate the procedure code and/or diagnosis code that is flagging the rejection. At this point it would be necessary to consult a payer specific billing guide, or to contact the payer to find out how the codes should be billed.

When UnitedHealthcare receives a claim from a care provider’s clearinghouse or practice
management system, a Smart Edit message is returned within 24 hours.
− If you receive a Smart Edit message, you’ll have five calendar days to correct the
claim. Otherwise, it will automatically be processed.

 

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