Pre-Claim Review

Home health agencies (HHAs) are subject to the Review Choice Demonstration (RCD). Medicare Administrative Contractors (MACs) are required to review an HHA’s documentation to determine if beneficiaries meet home health coverage requirements per the Medicare Benefit Policy Manual, chapter 7 (PDF, 494 KB).

Palmetto GBA offers HHAs a number of resources for navigating the RCD Pre-claim review process, including checklists, a video and forms.

What Is the Pre-Claim Review Option?
Pre-claim is a process through which a request for provisional affirmation of coverage is submitted for review before a final claim is submitted for payment. Pre-claim review helps make sure that applicable coverage, payment and coding rules are met before the final claim is submitted. You can find answers to frequently asked questions on the CMS website (PDF, 316 KB).

Certifying Physician

Checklists

Illinois

LUPAS

Non-Affirmations

Resubmission

UTN


Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

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Jurisdiction J Part A MAC

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Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

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