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:
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 contact our offices at 216.791.3580 to obtain the authorization number prior to providing services.
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 visits requires authorization. Contact 216.791.3580 anytime, day or night. Clinicians are available 24/7 to provide authorization.
If you have a claim submission, please submit it within 120 days from the date of service to the following address:
7700 Equitable Drive
Eden Prairie, MN 55344
For electronic claim submission (Emdeon/Change Health), please use payer ID: 31149.
eClusive is our third-party administrator for claims. They are able to assist you with claim status including payment and denial information. Please allow 30 days from claim submission prior to following up.
eClusive can be reached via phone 952.400.7600 or fax 855-423-8919.
*Effective February 1st, 2020 McGregor PACE will change our TPA from Eclusive to Peak TPA. Please submit ALL CLAIMS beginning February 1st to Peak TPA using one of the following options:
EDI Payer ID: 27034
c/o Peak TPA
PO Box 21631
Eagan, MN 55121
Interested in signing up for electronic funds transfer? Please complete the EFT form and return to eClusive with a voided check or bank letter to email@example.com.
Download EFT Form
In the event McGregor PACE denies your claim, you may submit an appeal directly to the Plan requesting 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 216.851.8200 (ask for the appeals department) for the status of your appeal.
Have More Questions?
If you’re a provider and you have more questions, please contact us directly.
Contact McGregor PACE