Home Health Claims Adjusted Based on Recovery Auditor (RA) Automated Reviews

Published 04/09/2017

In September 2016, the Recovery Auditor (RA), Coviti, conducted Home Health automated reviews with early/late denials for agencies submitting claims to Palmetto GBA. These reviews consisted of claims that were submitted with an incorrect Treatment Authorization Code. The RA adjusted the HIPPS code based on the incorrect TAC code. As a result, the RA has directed Palmetto GBA to adjust these claims and recoup the funds where overpayments exist. Providers that have received overpayment demand letters may appeal the claims by requesting a redetermination. Providers should follow the steps below when submitting their requests for redeterminations.

  • Only include those claims where demand letters have been issued.
  • Submit a redetermination request for all claims after a demand letter has been received through eServices or by using the Redetermination Request Form (PDF, 233 KB).
  • Submit the correct Treatment Authorization Code with your redetermination request. If you have already submitted a redetermination without the corrected TAC codes, submit the corrected TAC codes with the beneficiary name, Medicare ID number and dates of service.  Do not submit a new request for a redetermination.
  • If the original HIPPS code submitted on the claim is correct, omit the HIPPS code from your request. Otherwise, submit the correct HIPPS code
  • Do not submit the Treatment Authorization and HIPPS codes that were originally submitted on the claim with your request.
  • Please allow 60 days for processing of the redetermination(s).
  • Providers should not submit a rebuttal. If a provider has submitted a rebuttal, it will be returned.

The Treatment Authorization Code and HIPPS codes (if applicable) may be submitted with your request in the following format:

PIN/NPI: _________________

Date: ____________________

Requestor: ________________



Demand Letter Number
Claim Number
Beneficiary Name & Medicare ID Number
Dates of Service
Correct HIPPS Code (if applicable)
Correct TAC

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