Pre-Claim Review
Pre-claim review is a Medicare process in which a home health agency submits the documentation supporting a claim to the review contractor before the final claim is billed, rather than after. Affirmed requests receive a Unique Tracking Number (UTN) that goes on the claim, which then pays without further medical review of those services. It is the flagship option under the Review Choice Demonstration (RCD) in six states.
Definition
Pre-claim review is a Medicare process in which a home health agency submits the documentation supporting a claim to the review contractor before the final claim is billed, rather than after. Affirmed requests receive a Unique Tracking Number (UTN) that goes on the claim, which then pays without further medical review of those services. It is the flagship option under the Review Choice Demonstration (RCD) in six states.
Why it matters
Pre-Claim Review is part of the Compliance & Survey vocabulary used across home health operations, documentation, and revenue cycle. Understanding it helps clinicians, QA leads, and administrators stay aligned on care quality and compliance.
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