Review Choice Demonstration Ohio Selection Results

Published 06/11/2021

Round Pre-Claim Review (PCR) Postpayment Review Minimal Review Selective Postpayment Review Spot Check
Round One 84% 14% 2% 0% 0%
Round Two 75% 7% 1% <1% 16%
Round Three 42% 47% 1% 1% 8%

Option 1: Pre-Claim Review (PCR) – 100% of requests are reviewed to determine medical necessity prior to claim submission. If this option is selected, you will participate in this option until the next selection period.

Option 2: Postpayment Review – 100% of claims are reviewed after final claim submission. If this option is selected, you will participate in the option until the next selection period.

Option 3: Minimal Review –  Providers are not subject to MAC claim edits and 100% of claims have a 25% payment reduction. All providers who make this selection may be referred to the Recovery Audit Contractor. If this option is selected, you will remain in the option for the duration of the demonstration and will not have an opportunity to pick a different option later.

Option 4: Selective Postpayment Review – A statistically valid percentage of claims are reviewed every six months based upon the total universe of claims submitted within the six-month cycle. If this option is selected, you will remain in the option for the duration of the demonstration and will not have an opportunity to pick a different option later.

Option 5: Spot Check – 5% of claims are reviewed after final claim submission and prior to payment. If this option is selected, you will participate in the option until the next selection period.


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