Medically Unlikely Edits Logic for Span-Dated Claims – New Implementation Date

This notice is an update to the previous communication regarding Medically Unlikely Edits (MUEs) for span-dated claims, which was originally scheduled to be effective March 1, 2026. Due to unexpected circumstances, the initial implementation date of March 1, 2026, has moved to Sept. 1, 2026.

Summary of Policy

As a reminder, Highmark applies MUEs to ensure members receive appropriate, cost-efficient care. To avoid processing errors and claim rejections or denials, professional providers must bill for individual dates of service instead of using span dates for claims subject to MUEs.

Highmark follows the National Correct Coding Initiative (NCCI) guidelines from the Centers for Medicare and Medicaid Services (CMS) and reserves the right to apply MUE edits outside of CMS values when clinically appropriate.

For more information, please see Reimbursement Policy (RP)-035 Correct Coding Guidelines.