Provider FAQs

The Program of All-Inclusive Care for the Elderly (PACE®) is a comprehensive, fully integrated, provider-based health plan for the frailest and costliest members of our society – those who require a nursing home level of care. The PACE philosophy is centered on the belief that it is better for frail individuals and their families to be served in the community whenever possible. Although all PACE participants are eligible for nursing home care, 95 percent continue to live at home.

PACE serves over 68,000 individuals in 32 states and the District of Columbia who are age 55 or over and certified by their state as needing a nursing home level of care.

The average participant is 76 years old and has multiple, complex medical conditions, cognitive and/or functional impairments, and significant health and long-term care needs. Approximately 90 percent are dually eligible for Medicare and Medicaid. PACE participants must live in a PACE service area and be able to live safely in the community with PACE services at the time of enrollment.

PACE participants are served by a comprehensive team of professionals:

• Upon enrollment in PACE, participants and their caregivers meet with an interdisciplinary team (IDT) that includes doctors, nurses, therapists, social workers, dietitians, personal care aides, transportation drivers and others.
• The IDT develops an individualized care plan that addresses and responds to all of the participant’s needs – 24 hours a day, seven days a week, 365 days a year.

PACE provides comprehensive health and supportive services and delivers regular, “high-touch” care to participants across a range of settings:

• At the PACE Center, they receive primary care, therapy, meals, recreation, socialization and personal care.
• In the home, PACE offers skilled care, personal care supportive services, and supports such as ramps, grab bars, and other tools that facilitate participant safety.
• In the community, PACE offers access to specialists and other providers.

PACE is both a health provider and a health plan:

• PACE combines the intensity and personal touch of a provider with the coordination and efficiency of a health plan.
• IDT members deliver much of the care directly, enabling them to personally monitor participants’ health and respond rapidly with any necessary changes.
• The PACE IDT is also responsible for managing and paying for services delivered by contracted providers such as hospitals, nursing homes and specialists.

Thank you for your interest in becoming a Care Guide Partners PACE network provider. To initiate the process, please email us at PACEInfo@careguidepartners.org or call 270.600.2580.

Claims for services rendered to Care Guide Partners PACE participants must be submitted on a current CMS-1500 form for professional services, CMS-1450 (UB-04) form for facility services, or ADA Dental Claim Form for dental services within the time frame stated in the provider services agreement or within 365 days for non contracted providers.

The preferred and fastest method for payment is to submit claims electronically through an EDI submission under payor ID# MPSAB. Providers can also upload claims directly to the portal. If you would prefer to upload claims directly to our clearinghouse, please contact MPS at (458) 802-4762 to set up an account.

Non standard providers can submit claims directly to P.O. Box 1369 Roseburg, OR 97470.

Care Guide Partners PACE participants pay no deductibles, copayments, or coinsurance for covered services, including prescription drugs. As a reminder, upon entering into a contract with Care Guide Partners to provide services for PACE participants, all providers agree to accept our payment(s) as payment in full, with no right to seek additional payments from Medicare, other insurance carriers or providers, or PACE participants.

Balance billing of a PACE participant is prohibited.