For Providers

PACE of Cincinnati provides the care and services older adults need to live their best lives at home.

At PACE of Cincinnati, our mission is to provide the care and services older adults need to stay at home. To accomplish our mission, we practice a commitment to seeing each participant as a unique individual with unique care needs. In addition to the services PACE participants receive at our PACE of Cincinnati day health center, we rely on a network of local, high-quality service providers who share our commitment to helping older adults live their best lives at home.

Becoming a PACE of Cincinnati Provider

To become a provider for PACE of Cincinnati, you must complete the contracting process and sign a provider agreement. The provider agreement contains the agreed upon rates for payment. If you are interested in becoming a provider for PACE of Cincinnati, call (513) 862-7223 or email paceofcincinnati@paceofcincinnati.org for more information.

Authorization for Outside Appointments

PACE of Cincinnati requires authorization for services that are referred outside of our center. We provide the authorization number in the paperwork that accompanies our participants to their appointment.

If you do have the authorization number at the time of our participant’s appointment, please call us at (513) 862-7223 to obtain the authorization number prior to providing services.

Emergency Visits and Inpatient Hospitalization Authorizations

Emergency services do not require prior authorization.

Providers should notify PACE of Cincinnati within 24 hours or on the next business day after the services are provided.
Please call us at (513) 862-7223 or email us at paceofcincinnati@paceofcincinnati.org.

Payment

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

Please call us at (513) 862-7223 or email us at paceofcincinnati@paceofcincinnati.org for information.

Submitting Claims

Per the PACE of Cincinnati provider agreement, claims must be submitted within 90 days from the date of service. All claims must be mailed to:

PACE of Cincinnati
4850 Smith Road
Cincinnati, OH 45212
ATTN: Claims

Invoices for services provided to PACE of Cincinnati participants must be submitted to PACE of Cincinnati within 90 days. Institutional providers should use Form UB92 (HCFA 1450) to submit their charges; primary care providers use form HFCA 1500; and all other providers submit standard invoices. To ensure timely payment, providers should inform their billing department that they must bill PACE of Cincinnati directly and not Medicare or Medicaid.

Any questions regarding claims submission or payments should be directed to PACE of Cincinnati at (513) 862-7223.

Appeals

In the event PACE of Cincinnati denies your claim, you may submit an appeal requesting a reconsideration of the decision. The appeal must be received by PACE of Cincinnati within 60 days from the date of the claim denial.

All appeals must be submitted to:

PACE of Cincinnati
4850 Smith Road
Cincinnati, OH 45212
Attention: APPEALS

Appeals may also be submitted by email at paceofcincinnati@paceofcincinnati.org.

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