McGregor's Response to the COVID-19 Virus
Are you a McGregor PACE provider? We’ve compiled some of the most requested information on the billing, claim submission, and appeal submission processes below:
To verify participant eligibility and coverage please call Peak TPA via phone 866.386.4447 or fax 314.961.3456 or please submit inquiries to firstname.lastname@example.org
Billing McGregor PACE
Thank you for providing care to our participants! At McGregor PACE, we want to provide a seamless and easy billing process for our outside providers.
Below outlines the frequently needed information for providers about billing the McGregor PACE Program:
McGregor PACE requires authorizations for services that are referred outside of our clinics. We provide the authorization number in the paperwork that accompanies our participants to their appointment.
If you do not receive the authorization number from the participant at the time of the appointment, please call our authorization line at 216.268.8543 or email email@example.com to obtain the authorization number prior to providing services.
Emergency Visits and Inpatient Hospitalization Authorizations
Providers may provide emergency services that are medically necessary without an authorization number. However, providers must notify McGregor PACE no later than the next business day from the emergency visit.
Admission for an inpatient stay due to emergency visit requires authorization. Contact 216.791.3580 ext 5040 anytime, day or night. Clinicians are available 24/7 to provide authorization.
Please fax all authorization requests (including applicable clinical documentation) to fax # 216.378.6238.
For electronic claims submission please use electronic payer ID: 31149
Peak is our third-party administrator for claims processing. They are the best source to assist you with claims status including payment and denial information. Please allow 30 days from claim submissions prior to follow up.
Peak can be reached via phone 952.400.7600 or fax 855.423.8919 or please submit inquiries to firstname.lastname@example.org.
We encourage all providers to receive payment electronically for the fastest and most efficient deliver of payment. McGregor PACE uses Payspan for electronic payment, electronic remittances, and electronic explanation of payment. Please follow the instructions received with the check received from PEAK or contact Payspan at Provider Support via email at email@example.com or by phone at 877-331-7154, Option 1.
In the event McGregor PACE denies your claim, you may submit an appeal directly to the Plan requesting a reconsideration of the decision. The appeal must be received by McGregor PACE within 120 days from the date of the claim denial.
All appeals must be submitted to:
14900 Private Drive
Cleveland, OH 44112
Appeals may also be submitted online by emailing firstname.lastname@example.org
Note: Providers are responsible for sending their patient's PHI and PII securely.
McGregor PACE will respond to your appeal in writing within 60 days from receipt of the appeal. Please allow 60 days from appeal submission to follow up on status. You can contact McGregor PACE at 216-268-8396 for the status of your appeal.
Note: PROVIDERS ARE RESPONSIBLE FOR SENDING PATIENT'S PHI AND PII SECURELY.