Pre-Claim Review Demonstration 2017 Update

Update: On March 31, 2017, CMS announced that as of April 1st, the Pre-Claim Review demonstration 2017 will be suspended for at least 30 days in Illinois. The demonstration will not expand to Florida on April 1, 2017. CMS will notify providers at least 30 days in advance via an update to their website of further developments related to the demonstration. HEALTHCAREfirst will continue to monitor the status of the Pre-Claim Review Demonstration and provide updates as information is made available.

On September 19, 2016, CMS announced that it would delay the start date of the Pre-Claim Review Demonstration 2017 for Florida. According to the CMS notice, ” Based on early information from Illinois, CMS believes additional education efforts will be helpful before expansion of the demonstration to other states; therefore, we will not move forward with initiating the demonstration in Florida in October. This education effort will focus on how to submit pre-claim review requests, documentation requirements, and common reasons for non-affirmation.” While a new start date for Florida has not been announced, CMS said it would provide at least 30 days’ notice prior to beginning the demonstration in any state.

This delay does not affect the Pre-Claim Review Demonstration 2017 in Illinois and these home health care providers are required to continue pre-claim review submissions.

Pre-Claim Review is a process by which a request for coverage is submitted for review before a final claim is submitted for payment. The Pre-Claim Review Demonstration began on August 3, 2016 in Illinois with Florida, Texas, Michigan, and Massachusetts scheduled to follow. As previously planned, CMS does expect a staggered start, beginning with Florida.

Click here to download A Guide to the Pre-Claim Review Process. For additional questions , please contact us.