Pre-Claim Review Update

Posted by Brian Tosh on Dec 20, 2016 3:46:27 PM


On December 2nd, the Centers for Medicare & Medicaid Services reported that Pre-Claim Review Demonstration affirmation rates had hit a high of 87% in the state of Illinois. While 83% of these requests were fully affirmed, another 4% received a partially affirmed decision. This is welcome news to providers who saw only a 66% affirmation rate during the first eight weeks of the program.

While it’s a positive sign that affirmation rates are trending up, this progress is coming at a cost. Processing pre-claim reviews can be incredibly elaborate and time consuming. You want to focus on patient care, and the additional resources these reviews require can get in the way of that. With the demonstration also expanding into Florida on April 1st, 2017, it's never been more important to ensure you're prepared.  It’s with these concerns in mind that eSolutions developed our Pre-Claim Review service.

Our service makes it a snap to electronically submit pre-claim review documentation. It features streamlined workflow and real-time business rules that are designed to support compliance expectations and help you avoid denials and penalties.

The Pre-Claim Review Service also features advanced data management that offers detailed reporting and analytics. You can easily manage pending and submitted pre-claim forms, navigate the status of returned responses and enjoy full integration with other eSolutions’ products.


This feature-rich service lets you master the challenges of the CMS Pre-Claim Review Demonstration. You get:

  • Efficient workflow for all relevant documentation and pre-claim review detail
  • Advanced business rules to support validation and UTN requirements of pre-claim submission
  • Secure, HIPAA-compliant submission and retrieval of documents supporting the encounter (with status responses)
  • Detailed reporting, tracking, and status updates on submitted pre-claims
  • Automatic delivery of relevant data from returned pre-claim responses

As inconvenient as the Pre-Claim Review Demonstration can be, all evidence points to its continued expansion to other states. We want to make sure you’re ready to take reviews on from the start!

Getting started!

If you’d like to see pre-claim review capabilities in action, we invite you to check out our short WebEx demo. We also offer a two-week, risk-free trial for you to check out the submission and management capabilities. Go ahead - see just how simple it really is. If you’re not convinced after the trial, you can simply terminate the service at absolutely no cost to you.


Just click the button above and select the option that works best for you. You can also call our Client Services department at 866-633-4726 if you have any questions.


Topics: home health, pre-claim review