Transitioning from Pre-Claim Review (PCR) to an Additional Documentation Request (ADR) Option

Published 01/20/2021

At the end of a Review Choice Demonstration (RCD) six-month Cycle, a Home Health Association (HHA)’s may choose a different review option. In some cases, the HHA may move from Choice 1 (PCR) to an option that involves ADRs. Choices that include generation of ADRs include:

  • Choice 2: 100% postpayment review
  • Choice 4: Selective postpayment review of a statistically valid random sample (SVRS) of claims every six months for the remainder of the demonstration; or
  • Choice 5: Spot Check Review of 5 percent of claims every six months to ensure continued compliance. This type of ADR review is done via pre-payment review.

The eServices Portal will be updated to reflect your new Choice selection. When transitioning from Choice 1 (PCR) to any other choice, the RCD tab in eServices will no longer be available for PCR submissions or resubmissions. If the HHA has a pending PCR submission, wait for the decision and UTN, and use that UTN when the claim is submitted. If the final decision is a partial affirmation or non-affirmation, submit the claim with the UTN. Any part of the claim that is denied can be appealed through the normal appeals process.