Improve Your 
PACE Administration Environment

 

PACE OS enhances your PACE Program with faster collaborations, streamlined processes, and better participant outcomes — all in one platform.

 

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Improve Your  PACE Administration Environment

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 With a 48% increase in elderly enrollment, outdated business processes will no longer help you meet the demands of a larger pool of elderly participants.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

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

PACE OS Minimizes Eligibility Denials with Supreme Accuracy

PACE OS Participant Enrollment Won’t Leave Them Waiting

 

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.

 

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Reduce denials and expedite registrations

 

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Understand and address participant’s healthcare needs

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Manage participants status through risk adjustment factor (RAF) score dashboard

 

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Check the participant’s authorization and claim-related details easily

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Configure assessment questions for case management, annual health, and more

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Perform various complicated transactions for multiple participants in one place

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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.

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Clinical Alerts

Manage recurrent automated alerts for coordinated clinical and administrative workflows to anticipate population health trends and reduce potential participant and provider risks.

 

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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.

 

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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.

 

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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.

Highest Industry Standard Payer Platform and PHI Protection

 

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.

Clinical Care

 

Provide effective coordinated healthcare services through powerful seamless inter-departmental work processes. Increase your PACE Program’s care management effectiveness with knowledge-engineering networks designed to incorporate technology and human  resources flawlessly.

 

Clinical Care

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.

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Contracting

 

Define the specifics of provider reimbursement configuration. PACE Programs are provided with the flexibility in their downstream capitation and  carve-out structures.

 

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Claims

Manage claims, disputes, and appeals with an advanced automation technology that makes the adjudication process faster and more efficient and with accurate calculation.

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Capitation

Build and calculate capitation-based reimbursement structures with accessible reporting capabilities for monthly or yearly capitation and primary care physician (PCP) capitation checks.

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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.

Population Health Management

Access clinical, financial, and operative data in real-time and get the collective insights you need to boost productivity while meeting value-based outcomes.

Coordinated Health

Our web-supported platform enables your team to bridge clinical information and communication gaps throughout your PACE Program, enabling better-informed delivery of care.

Who We Support?

 

Letting Our Clients Infuse Quality into Elder Care

 

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.

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