May 25, 2006


Claims Review




Beginning Friday, May 26, 2006 PACE will begin reviewing adjudicated claims with an anticipated reimbursement exceeding $500. This is being done to insure that these claims were billed properly to the Program when the medication was dispensed and to avoid the claim being disallowed upon audit at a later date.


Claims identified for this post adjudication review will be identified on the POCAS on-line response with an EOB of “745.” This PACE EOB identifies this claim as being “Pended for Audit Review.”


Pended Claims will not appear on the Provider’s PACE Remittance Advice until a determination has been made.


Providers will be notified by mail if additional documentation, such as verification that another payer denied payment, is necessary for payment.


PACE may elect to include additional claims in this review category

at a later date.



Questions may be addressed to Provider Services at