Member Training Opportunity on Claims Processing Issues

NPA will sponsor a webinar titled "EDI vs. Standard Claim Form vs. Invoice: How the Submission Method Impacts Your PACE Organization" on Tuesday, April 30, at 3 p.m. ET. Peak Health Plan Management Services, a subsidiary of Capstone, will provide the training, which is recommended for executive directors, CFOs, contract managers, and accounting or finance staff.

PACE organizations contract with many specialty organizations, some of which provide incentives or discounts, so they can simplify their billing. This training will explore the implications of your contract terms on regulatory reporting and the potential to impact your future Medicare and Medicaid revenue.

To register for the training, visit GoToWebinar. After registering, you will receive a confirmation email containing information about joining the webinar.

For more information, contact Lani Cadow, manager of Member Services.

NPA Shared Services: Claims Processing

Recognizing the importance of health plan management services for PACE organizations and in response to the needs of PACE organizations for technical assistance to prepare for and comply with CMS encounter data reporting requirements, NPA has selected the following strategic partners to offer claims management and enounter reporting services to its members.

Cooperative Managed Care Services

Cooperative Managed Care Services (CMCS) is a full-service third-party administrator offering state-of-the-art systems capabilities and personalized client management. The suite of services available includes medical claims administration, RAPS and encounter submissions, medical management, reporting, population health analytics and systems support tailored to the needs of PACE programs. CMCS takes pride in working with clients to meet their specific needs, even as they differ from comparable organizations.

CMCS excels in all areas that support managed health care organizations:

  • offers a variety of high-quality, service-oriented administrative and care management solutions;
  • provides optimal service through internal continuous quality improvement, resulting in operational efficiency and fiscal responsibility;
  • partners with clients through the development of interdisciplinary relationships;
  • offers integrated systems and seamless linkages enhancing easy access to information;
  • contributes to the improved financial performance of clients; and
  • develops and maintains systems and controls to ensure privacy and confidentiality.

The commitment of CMCS to quality service and a flexible approach to program design ensure exceptional value for our business partners. For more information, please visit the CMCS website.

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Peak Health Plan Management

Peak Health Plan Management, a service of Capstone Performance Systems, has more than 100 years of combined PACE and health plan management experience. Peak assists PACE organizations with financial management and fulfilling regulatory requirements for health plan functions. Peak's approach to health plan management is PACE-specific, so Peak can help your organization remain compliant, obtain accurate reimbursement, and measure performance. For more information, visit Peak Health Plan Management.


Among the wide range of services provided by Peak Health Plan Management are the payment and adjudication of medical claims, diagnostic information for the Medicare Risk Adjustment Processing System (RAPS), and reports on service utilization rates and trends.

Peak Health Plan Management has the expertise and resources to provide NPA members with the comprehensive array of services needed to understand, prepare for, and comply effectively with CMS encounter data reporting requirements. Peak can provide valuable and essential turnkey resources to PACE organizations in complying efficiently and effectively with those requirements.

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