I Am a Provider in an RCD State and My UPIC Just Ended. Now What Happens?

While a provider in a Review Choice Demonstration (RCD) state is under review by a Unified Program Integrity Contractor (UPIC), they are excluded from the RCD program. Providers under choice 1 (PCR) will receive a message stating that they are under a UPIC if they attempt to request a UTN and providers under an ADR option will stop receiving ADRs from Palmetto GBA.

Once a UPIC review ends, the provider will receive a letter from the UPIC to confirm the date that the review ended. If the review ends in the middle of a cycle, the provider is excluded from RCD until the next cycle begins. 

Example

• The UPIC review ends on March 5
• The next cycle begins on April 1
• Provider is excluded from RCD from March 5 – March 31
• Provider will participate in RCD beginning April 1

Important Notes

1. Providers are expected to make a choice selection for an upcoming cycle while they are actively under a UPIC review. This way, if their UPIC ends after the selection period but before the beginning of the next cycle, their selection has already been made and they can move back into the RCD program without further delay.
2. The provider will also receive a letter from Palmetto GBA to confirm that the review has ended but the effective date is determined by the letter from the UPIC
3. All claims submitted with a date of submission on or after the start of the next cycle are subject to the demonstration

Additional Resources

•    Providers Under a UPIC Review Do Need to Make an RCD Selection
•    Understanding ADRs When Participating in the RCD
•    Review Contractor Directory — Interactive Map
•    Review Choice Demonstration (RCD) for Home Health (HH) Services Frequently Asked Questions (FAQs) — Questions 19 and 20 (PDF)