As implementation for the Pre-Claim Review Demonstration is being finalized by CMS, your agency has the opportunity to get a head start on what’s to come. CMS has announced that the next state to participate will be Florida starting April 17, 2017. Texas, Michigan, and Massachusetts are still delayed but will be announced soon.

While the documents necessary for PCR submission are not changing, the time line and scrutiny of information is. Let our experienced and knowledgeable staff help ready your agency for the Pre-Claim Review Demonstration. MJS will work diligently with and for your agency to make sure you do not fall behind.

Pre-Claim Services:

Addendum to Comprehensive Assessment  and Addendum to Comprehensive Assessment Instruction Guide for Skilled Nurses


Addendum to Comprehensive Assessment and training manual will provide:

  • Guidance to ensure proper documentation is included in PCR submission to obtain first-run AFFIRMED Status
  • Tool for submitting information in lieu of sending the OASIS in whole or any part Clarification of components needed to fulfill homebound requirements, including Criteria 1 and 2, Components 1 and 2 with checklists support using ICF scales
  • Tool for submitting components necessary to support Medical Necessity
  • Examples with explanations for frequent occurring Diagnoses including Homebound/Medical Necessity support
  • Further support for HB/MN that can be signed by PHYSICIAN and incorporated into PHYSICIAN and HHA records

For more details and to place an order, please click Order Form to download PDF or contact Sagan Adams.


Preliminary Pre-Claim Prep

Send our staff 10 claims prior to submission for physician signature. Our compliance RNs will check the documents for all the required eligibility and coverage standards. You will receive a detailed report that explains which areas need adjustments. The assigned RN will then provide a personalized educational training session via phone conference or webinar in which we will go over the results of the review in detail and discuss how you can improve your readiness. For more information, click the link below.

Pre-Claim Review

MJS has developed a Pre-Claim Review service specifically designed to prepare your agency’s claims for proper submittal to obtain a front end, first time affirmed decision. There are 4 steps; Pre-Claim Reveiw, Pre-Claim Submission, Claim Filing, and Claim Appeals. This service will ensure your packet meets requirements while your plan of care is out for physician signature. This makes submittal smoother, faster, and more efficient. For information, click the link below.

We look forward to partnering with you and making the Pre-Claim Reveiw Demonstration process a smooth and financially rewarding transition. Please feel free to contact us with any questions regarding our Pre-Claim Services. We are here to help!

T: 936-559-7234    F: 936-560-4652

MJS & Associates, LLC Pre-Claim Service

Powerful Healthcare Solutions