Pre-Claim Review

Published 12/11/2023

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).

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).

Certifying Physician


Centers for Medicare & Medicaid Services (CMS) Resources




Initial Submission/Resubmission


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