Attention Texas Home Health Providers: You May Begin Submitting PCR Request on March 2, 2020

Attention Texas Home Health Providers: Cycle 1 begins on March 2, 2020. If you selected Option 1 - Pre Claim Review (PCR), you may begin submitting your PCR request for any billing period on or after March 2, 2020. The Unique Tracking Number (UTN) received with the PCR decision must be submitted on every claim with a billing period start date on or after March 2, 2020.  If a UTN is not submitted on the claim, the claim will ADR and a 25% payment reduction will result. This includes billing periods where the second 30-day period within the 60-day episode of care begins on or after March 2, 2020.

For example, if the episode of care began February 17, 2020, the first 30-day billing period would not be included in the Review Choice Demonstration (RCD) because this is prior to the Cycle 1 start date (March 2, 2020). The second billing period in this example begins on or after March 2, 2020; therefore, it is included in the RCD and would require a PCR request.


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