Provider Resources

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.

PLEASE NOTE: WE ARE CHANGING OUR CLAIMS PROCESSER JANUARY 15, 2025. IMPORTANT CHANGES ARE LISTED BELOW.

Verifying Participant Eligibility

Effective February 1, 2025, please call Innermark TPA at (618) 619-2184 or email [email protected] to sign up for our provider portal.

Billing McGregor PACE

Thank you for providing care to our participants! We want to provide a seamless and easy billing process for our outside providers. You will find the most frequently needed information for providers about McGregor PACE billing below.

Authorization for Outside Appointments

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 216.202.1654 or email [email protected] to obtain the authorization number prior to providing services.

Effective February 1, 2025, please email [email protected] to sign up for our provider portal to look up existing authorizations.

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 an emergency visit requires authorization. In most cases, we are notified of this transition when it occurs. Please review the innermark provider portal to see if the authorization has already been provided. If you do not see this authorization, please contact 216.339.1253 during business hours or 216.791.3580 after business hours. Clinicals should be faxed to 216.916.4092. Clinicians are available 24/7 to provide authorization.

Please email all authorization requests (including applicable clinical documentation) to [email protected].

Claim Submission

Please submit the claim within 120 days from the date of service to the following address:

McGregor PACE
C/O innermark TPA
PO Box 21002
Eagan, MN 55121

For electronic claims submission please use electronic payer ID: 98481

Our TPA (third-party administrator for claims processing) is 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.

Innermark TPA can be reached via phone at 618-619-2184 or email [email protected] to sign up for our provider portal.

Payment

We encourage all providers to receive payment electronically for the fastest and most efficient delivery of payment. McGregor PACE can issue electronic payment, electronic remittances, and electronic explanation of payment.

Please email Innermark TPA at [email protected] to gain access to our Provider Portal to set up electronic payment and obtain access to electronic explanation of payments.

A W-9 is required to be on file prior to any payment being made to any provider. NO PAYMENT WILL BE MADE WITHOUT A W-9 ON FILE. If your claim is denied for no W-9 on file, please email your W-9 to [email protected] and then submit a new claim.

Appeal Submission

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 60 days from the date of the claim denial.

All appeals must be submitted to:

McGregor PACE
14800 Private Drive
Cleveland, OH 44112
Attention: APPEALS

*Appeals may also be submitted online by emailing [email protected]

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 216.205.4016 for the status of your appeal.

Note: Providers are responsible for sending patient’s PHI and PII securely.

888-895-PACE (7223)*