How does review choice work in Illinois, Ohio, Texas, North Carolina, Florida and Oklahoma in 2026?
The short answer
If your agency bills Medicare in Illinois or Texas, your next pick is due November 15, 2026, a Sunday, so aim for Friday, November 13. Review choice is how Medicare checks every home health claim in six states: you choose whether claims are reviewed before you bill or after you're paid, and a 90% approval rate opens lighter options. In our read, if your rate is comfortably above 90%, try spot check first; otherwise stay in pre-claim review.
If you bill Medicare in Illinois or Texas, your selection window is open now. Palmetto GBA, the contractor for home health in all six review choice states, runs it through Sunday, November 15, 2026. Its notices don't say whether the portal takes a Sunday selection, and its phone line is open weekdays only. So treat Friday, November 13 as your real deadline.
Palmetto said results letters would go out by the end of October. They come the way your agency already gets Palmetto's mail: the eServices message inbox, post or fax. No letter yet? Check the eServices inbox first, then call Palmetto's provider contact center at 855-696-0705.
Fine print
If you hit 90% and don't select, CMS's operational guide says you "will automatically be assigned to participate in Choice 3: Selective Postpayment Review, and will remain here for the duration of the demonstration." CMS's FAQs say the demonstration ends May 31, 2029, unless it's extended.
Your state's next dates
From Palmetto's cycle notices:
- Illinois and Texas: selection November 1 to 15, 2026, and the new cycle starts December 1. Next window: July 1 to 14, 2027.
- Ohio, North Carolina and Florida: cycle ends February 28, 2027. Results by March 31, selection April 1 to 14, new cycle May 1.
- Oklahoma: cycle ends January 31, 2027. Results by February 28, selection March 1 to 14, new cycle April 1.
Put your window on the calendar the day your letter lands. You can change your pick until the night the window closes. Staying in pre-claim review? eServices can keep that choice for future cycles, and you can withdraw later.
In Ohio, CMS lists CGS for Part A and Part B claims, but home health, review choice included, goes to Palmetto.
How your score is counted
- Each billing number (PTAN) gets its own score. Every NPI under it rolls into one result; three PTANs mean three selections.
- Only full approvals count. A partial approval is a miss. Resubmit as often as you need before the final claim; CMS doesn't count resubmissions or appeals against your rate.
- You need at least 10. Under 10 requests or claims, you're back to choosing between pre-claim review (Choice 1) and 100% postpayment review (Choice 2), whatever your percentage.
- The months between cycles count forward. October and November 2026 decisions go into the next cycle's results.
That 10 is per PTAN: one that sent nine requests, all approved, still can't move to lighter review.
What qualifying gets you
At 90% or better on at least 10, you pick one of three. Choice 2 drops off the list; it's only offered below the bar.
| Choice 1: pre-claim review | Choice 3: selective postpayment review | Choice 4: spot check review | |
|---|---|---|---|
| What's reviewed | Every 30-day billing period | A random sample, sized from your last six months of claims | A random 5% of claims, sized from your last six months |
| When | Before you send the final claim | After Medicare pays | Before payment |
| How long you stay | Each six months you hold 90% | Until the demonstration ends, whatever your rate | Each six months you hold 90% |
| If your rate drops | Back to Choices 1 and 2 | Nothing changes | Back to Choices 1 and 2 |
Moving from pre-claim review to spot check? CMS's FAQs say claims with an approved tracking number (UTN) from your pre-claim months won't be picked.
Which one we'd pick
In our view, spot check is the one to try first if your rate sits comfortably above 90%. Reviews shrink to 5% of claims, and if a bad stretch pulls you under 90%, you can go back to pre-claim review.
Stay in pre-claim review if your rate has hovered near 90%, or if many referrals arrive thin. You find out about a weak chart before you bill it.
Choice 3 fits an agency that wants lighter review locked in through May 2029 and can absorb a denial on money it's already been paid. CMS doesn't say how many claims the sample will be.
Most agencies stayed in pre-claim review: in fiscal 2024, CMS counted 2,798 there, 64% of the total, against 466 in spot check and 209 in selective postpayment review.
Sending more than one billing period
In your states, one pre-claim request can cover two or more 30-day billing periods.
- Select the multiple billing period option. CMS ties it to "the applicable review cycle" without saying which cycles qualify, so check eServices before you count on it.
- Send the documentation for each period. Every period you add needs its own valid plan of care.
- Expect one UTN per period. The decision can approve some periods and not others.
Resubmissions, and anything sent through esMD (Medicare's electronic document system), cover one period only. A California agency won't have this option: California's rules require one request per 30-day period, each with the whole episode's paperwork.
What reviewers turn down most
The reviewer is checking the same list Medicare always uses: the patient is homebound, under a practitioner's care, on a plan of care, needs skilled services, and had a face-to-face visit related to the main reason for home health, no more than 90 days before or 30 days after the start of care. A gap in any one of those is a non-affirmation.
Three of Palmetto's top five reasons are about that face-to-face visit: it wasn't related to the main reason for care, the visit note was missing, or the visit fell outside the time limits or the certifying physician didn't date it. The other two are a thin plan of care and a later episode with no valid initial certification. Palmetto posted that list in June 2021, totalled across its review choice states.
Kevin LeGrand of LiveWell Partners, in pre-claim review in Illinois and Ohio, told Home Health Care News: "You want to make sure your orders team, your clinical team, that everybody’s in lockstep when they are working these Medicare patients …"
What a rejection means
Palmetto couldn't process the request, say for a Medicare Advantage patient, a bad PTAN or no clinical documents. Nobody reviewed whether the care was needed, so it doesn't count as a non-affirmation. Fix the problem and send everything again.
What a non-affirmation means
The packet fell short. The letter lists every reason, and for a paperwork error on a patient who seems to qualify, Palmetto also calls. Resubmit the complete package with the non-affirmed UTN, and you'll hear back within 10 business days. You can't appeal the decision itself, but you can send the final claim, take the denial and appeal that.
Your plan for the next cycle
- Confirm your account administrator now. Only that person can select in eServices.
- Select for every PTAN. Save each confirmation. Palmetto's lookup tool shows a new selection about 48 hours later.
- Count your own rate as decisions come in. Full approvals over decisions, per PTAN.
- Sort non-affirmations by reason. If face-to-face reasons keep showing up, take them to the referral sources they come from.
Enzo is a home health EHR. Enzo Intake checks each referral package for face-to-face documentation the moment it arrives and flags gaps before your team gets involved, while you can still ask the referral source for what's missing. Enzo QA reviews every chart before submission, including Plan of Care alignment, and shows your team what needs attention and why; your team makes the call.
Questions agencies are asking
We sent a request under the wrong PTAN. Can we just resubmit?
No. CMS's FAQs say to send a new initial request under the right PTAN, not a resubmission. Both requests count in your rate.
We're buying an agency in one of these states. Does its review choice come with it?
Yes. CMS says the new owner continues the previous owner's selection, and approved decisions and UTNs transfer too. If the seller was in Choice 3, you stay in Choice 3; otherwise you can pick again at the end of the six-month cycle.
We serve patients across a state line. Are those claims in?
Yes, if your agency is in one of the six states, CMS's FAQs say. A branch outside them that bills under its own NPI and PTAN is not.