Altamash Mir Healthcare Consultant

1
Pre-Claim Review for Home HealthAgencies
Documentation Requirements

• altamashmir.com

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Home Health Agency must know

• Pre-claim Authorization is needed for ALL New
  Patients (SOCs) any patients being
  Re-certified (Recerts) after the implementation
  date.
• Agencies could send pre-claim authorization
  requests two weeks prior to the implementation
  date.
• Agencies can send requests anytime between the
  SOC the end of episode, but before submission
  of the final claim of that episode.
• Agencies cannot put patient care on hold, while
  waiting for Pre-claim authorization request
  decision! You are still held liable for a patient
  that has been admitted to your agency!
• Utilize the form that we have developed to send
  your Pre-claim authorization requests (email to
  request)

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Process for submitting requests

• Receive orders from the MD to see a patient
• Have the Physician/Practitioner provide the
  Agency with a Face to Face Evaluation of the
  patient
• Evaluate the patient (SOC or REC) develop a
  plan of care (485)
• Have the Physician/Practitioner review sign the
  plan of care
• Review Complete the Pre-Claim Review Request
  Form
• Attach the required information upload
  (preferred), fax or mail the information to your
  MAC
• Keep a record of all claims submitted tracking
  sheet follow up on requests submitted 10 or
  more days ago diligently on a daily basis
• Once a UTN (Unique Tracking Number) has been
  assigned to an approved claim, enter the UTN on
  your tracking sheet (youll need it at final
  billing). CMS has stated that they will try their
  best to issue the Provisional Affirmative or
  Denial Decision letters to providers within the
  10 days of the submission of requests
• Submit Final Claim upon the end of the episode
  with the UTN number on UTN in field locator 63 of
  a paper claim 1450 (UB-04), further guidelines
  are being awaited for Electronic Claims

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How to deal with Denials

• If a pre-claim authorization request has been
  denied, the Home Health Agency may re-submit the
  request with the supporting documents to satisfy
  the requirements.
• The MACs will have 20 days to review the
  re-submitted documentation get back to the
  provider. A provider is allowed an unlimited
  number of resubmissions for pre-claim review
  requests that have not been affirmed.

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Contact Us

• Contact us to get more information or visit
  our website
• http//altamashmir.com/