• Address: St. Louis, MO 63119, United States

Delivering high-quality care to your participants.

PeakTPA provides services that optimize your organization’s financial management and fulfill regulatory requirements for health plan functions. Our expertise in health plan management, particularly in PACE, means you can focus on delivering high-quality care to your participants.

Encounter Data Processing and Submission

Encounter Data Processing and Submission

PeakTPA submits encounter data to CMS based on claims received electronically or on paper. Peak provides encounter data submission and error correction for PACE organizations based on claims, which is crucial for achieving accurate reimbursement. PeakTPA also submits encounter data to many states. Ask if we submit to your state already!

Claims Adjudication

Claims Adjudication

PeakTPA provides complete claims adjudication, processing and payment for your PACE program. We provide monthly claims expense reports organized by service and specialty type.

Enrollment Management/Billing/Reconciliation

Enrollment Management/Billing/Reconciliation

PeakTPA submits your monthly enrollment file to CMS in a timely manner. We verify the PACE program is receiving proper payment from CMS related to state and county code, Institutional Indicator, ESRD Status and Part D components.

Accounts Receivable

Accounts Receivable

PeakTPA posts Medicare and Medicaid Revenue and payments by participant and payer for distribution of the monthly Accounts Receivable Aging Report. We also submit the MMR to the PACE Data Analysis Center (PDAC) and provide all related journal entries.

Coordination of Benefits/Medicare Secondary Payer (MSP)

Coordination of Benefits/Medicare Secondary Payer (MSP)

We submit coordination of benefits data to the Electronic Correspondence Referral System and assist with the annual MSP Survey.

Risk Adjustment Data Submission

Risk Adjustment Data Submission

PeakTPA submits risk adjustment data to CMS based on claims and encounters received, follow-up and correction of errors, and submission of return files to PDAC. Our system allows you to track your RAPS data submission status real time.

Medicare Part D Submissions

Medicare Part D Submissions

Medicare Part D services involve submitting Prescription Drug Event (PDE) Data to CMS, including error correction and re-submission, all provided by PeakTPA. We provide the return files to PDAC and process monthly plan-to-plan (P2P) reports and payments. PeakTPA sends TrOOP notifications to disenrollees as required.

Reporting

Reporting

A library of reports is available for printing at any time. These reports provide helpful insights regarding the performance of your PACE program.

Implementation

Implementation

The six- to eight-week implementation plan includes weekly calls with your staff to ensure a smooth transition to PeakTPA services. The timing of training is based on the client’s need.

Want to learn more?

We are always here to help answer any questions. you may have. For more information on how PeakTPA can serve your organization, call us at (833)-609-4609, or click the button below.