Services
Claims Adjudication & Payment
Peak PACE Solutions provides complete claims adjudication, processing and payment for your PACE organization. Peak PACE Solutions claims adjudication and payment services include:
- Enter and process all claims received for services provided to PACE enrollees
- Create and submit positive pay files as needed
- Validate correct APC and DRG codes and pricing utilizing claims auditing software
- Generate payment and remittance advice weekly or other defined intervals
- Communicate with PACE representatives and providers to ensure accurate payment
- Request and process new and updated provider contract information as needed
- Provide weekly report of unauthorized claims
- Collaborate with PACE staff to determine each permanently placed participant’s cost share and make proper deductions from the monthly nursing home bills as appropriate
- Notify providers who submit bills to participants or the PACE organization to submit claims directly to PEAK
- Customize the PPS System pricing schedule as needed for services without standard coding
- Generate denial letters
- Generate pre-check register and check register
- Generate monthly journal entry per the PACE organization’s financial close calendar
- Claims authorization – provide access to Peak’s System for PACE organization’s staff to enter serve authorizations. Additionally, Peak will process electronic service authorizations imports based on Peak’s file specifications. Peak’s staff will manually enter the PACE organization’s authorizations into the Peak System at an additional charge.
- Calculate and report your monthly IBNR
- Provide your Accounts Payable aging report