Attention Oklahoma Home Health Providers Who Select Choice 1 (Pre-Claim Review): You Will Begin Submitting PCR Requests on December 1, 2023

Attention Oklahoma Home Health Providers: Cycle 1 begins on December 1, 2023. If you select Option 1 — Pre-Claim Review (PCR), you may begin submitting your PCR requests for any billing period on or after December 1, 2023. The Unique Tracking Number (UTN) received with the PCR decision must be submitted on every claim with a billing period start date on or after December 1, 2023. If a UTN is not submitted on the claim, the claim will ADR and a 25 percent payment reduction will result. This includes billing periods where the second 30-day period within the 60-day episode of care begins on or after December 1, 2023.

For example, if the episode of care began November 17, 2023, the first 30-day billing period would not be included in the Review Choice Demonstration (RCD) because this is prior to the Cycle 1 start date (December 1, 2023). The second billing period in this example begins on or after December 1, 2023; therefore, it is included in the RCD and would require a PCR request.

Special Note: Some Oklahoma providers were told that all dates of service will be subject to the review choice demonstration as of December 1, 2023. That information was incorrect, and the above statement will supersede that information.