Medically Unlikely Edit (MUE) vs Day Units Time (DUT) and date spans

MUE indicates that it is unlikely that more than x-number of an item would be used in a day. This causes confusion as so many items are ordered on a 30-day or even a 90-day basis. It is important to note that not all codes have a DHA determined MUE. Supplies should be filed using the date of service, not a date span and should indicate the DUTs (code A7033 billed with 90 DUTs). View list of MUEs

Providers need to verify all information before sending to claims processing. This field represents the number of units of an item you are submitting. For example, in the observation world 1 unit = 1 hour.

Note: Do not file claims with future dates.

Not all service units represent the same measure. Please be sure you know what, if any, units are associated with the code you are submitting on a claim.

There are specific supplies that are distributed in a measure greater than a daily supply. These items are date spanned. There are very few of these and you should check before submitting a date-spanned claim (example: Date span 01/01/14-01/31/14 for code B4035, and 31 as the DUT).

 

Claims denied/rejected due to exceeding MUE/DUT limitations

Requests for reconsideration are an option for providers when services or supplies are denied or rejected due to units or services exceeding the daily limit. Reconsideration will not be considered for luxury or upgraded DME items. Reconsiderations must include documentation that supports the units billed, with as much clinical support as possible. Please follow the “reconsideration process” instructions. See coversheet and tips for filing a reconsideration. Please do not confuse this with the initial claim filing and supporting documentation. This is a reconsideration process after claims have been denied.

TRICARE claims information