North Carolina Selection Results Round 1 Data

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: Post Payment 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 Post Payment Review – A statistically valid percentage of claims are reviewed every 6 months based upon the total universe of claims submitted within the 6 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.