Improve Your
PACE Administration Environment
PACE OS enhances your PACE Program with faster collaborations, streamlined processes, and better participant outcomes — all in one platform.
Defining The Program of All-Inclusive Care for the Elderly
PACE provides comprehensive medical and social services to qualified elderly participants in the community, who are mostly eligible for both Medicare- and Medicaid-covered services. PACE Programs focus on adult day health centers and are supplemented by in-home and referral services according to the enrollee’s needs with high-quality life outcomes.
Coordination in the Moments of Care
PACE Programs are now facing unprecedented pressure to exceed quality and engagement in healthcare. With a 48% increase in elderly enrollment, outdated business processes will no longer help you meet the demands of a larger pool of elderly participants.
$3.8T
U.S. healthcare costs grew 4.6%
55K
Total # of PACE participant-participants grew 48% from 2012 to 2020
69.4M
Projected older population by 2030
63.4%
Elderly/disabled participants share of total Medicare and Medicaid spending
12M
Number of enrollees who are dually eligible for Medicare/Medicaid
70%
Dually eligible PACE participants share with at least 3 chronic conditions
$1,000
PACE OS Minimizes Eligibility Denials with Supreme Accuracy
PACE OS Participant Enrollment Won’t Leave Them Waiting
Untimely filing and insufficient information are a couple of the most common mistakes that results to eligibility denials. You can prevent that from happening. Allow your participants to experience improved quality of life by getting them the provider and care they need on time.
PACE OS is a simple and effective platform that enables you to verify the eligibility of a health plan participant with great accuracy and speed, while eliminating denials and fraud.
Reduce denials and expedite registrations
Understand and address participant’s healthcare needs
Manage participants status through risk adjustment factor (RAF) score dashboard
Check the participant’s authorization and claim-related details easily
Configure assessment questions for case management, annual health, and more
Perform various complicated transactions for multiple participants in one place
Fix and correct eligibility discrepancies to successfully further final validation
Intuitively Streamlines Your Operations
Smoothly guide your PACE Program through the whole healthcare process cycle for increased accuracy and efficiency.
Clinical Alerts
Manage recurrent automated alerts for coordinated clinical and administrative workflows to anticipate population health trends and reduce potential participant and provider risks.
Case Management
Stratify risk and manage health population through a dedicated case management tool with unlimited programs that can help produce participant data analysis and actionable insights to deliver improved health outcomes.
Referral and Claims Administration
Easily facilitate authorizations and claims data lifecycles from start to finish through a reliable AI-based adjudication system for a more seamless workload integration.
HEDIS
Build highly effective, quality, value-based healthcare management programs to improve HEDIS ratings and boost your PACE Program’s ranking by integrating intuitive artificial intelligence networks for elevated participant engagement practices.
Highest Industry Standard Payer Platform and PHI Protection
Secure, proprietary, and embedded HIPAA-standard EDI formats to protect sensitive patient health information. Powerful encryption measures support your PACE Program with sustained defense against unwanted data breaches.
How PACE OS Helps Your PACE Program
Our comprehensive solution empowers your PACE Program to modernize processes throughout the continuum of care and create long-term value.
Financial Management
Oversee, analyze, and forecast financial movements based on constantly-updated health plan information. Your PACE Program can easily harness budgetary projections and quickly assess fiscal advantages through critical organized reports that track each claim’s entire process flow.
Contracting
Define the specifics of provider reimbursement configuration. PACE Programs are provided with the flexibility in their downstream capitation and carve-out structures.
Claims
Manage claims, disputes, and appeals with an advanced automation technology that makes the adjudication process faster and more efficient and with accurate calculation.
Capitation
Build and calculate capitation-based reimbursement structures with accessible reporting capabilities for monthly or yearly capitation and primary care physician (PCP) capitation checks.
IBNR Reporting
Generate incurred but not reported (IBNR) reports for paid and unpaid claims containing due amount details to easily organize, track, and monitor medical bills and claims payment.
Who We Support?
Letting Our Clients Infuse Quality into Elder Care
With PACE OS, we help PACE Programs achieve their mission-driven goals in healthcare. From faster interdisciplinary team communications to personalized care delivery, our capabilities enable PACE Programs to achieve unparalleled efficiency, transparency, and reliability at every stage of the participant journey.
Set your care team up for success with an all-inclusive solution. Join us in the transition to better care and experience seamless interoperability, participant engagement, decision-making, and jaw-dropping participant outcomes.
info@paceos.com
8795 Folsom Blvd., Suite 205,
Sacramento, CA 95826