Trusted Claims Performance. Greater Financial Control
PACE claims adjudication and pricing, shows claims and payment activity in real time, and documents every decision as it's made.
Run Claims Smarter
PACEClaims automates the complexity of PACE.
PACE organizations operate as both healthcare providers and full-risk insurance plans. Every claim decision has a direct impact on financial performance, compliance, and the ability to manage the cost of care.
Yet many claims operations still depend on manual touchpoints, disconnected systems, inconsistent pricing, and audit trails reconstructed after the fact.
PACEClaims changes that.
PACEClaims automates routine adjudication, provides real-time visibility into claims and payment activity, and documents every claim decision as it happens—giving your team greater efficiency, control, transparency, and confidence.
Impact: Automation & Outsourcing changes the economics of claims administration.
ROI of 240%
The amount of investment recouped within six to nine months of implementing an automated claims process into their healthcare organization.
Up to 15%
Percentage of improved claims denial rates when RCM functions are outsourced.
25-35%
The increase in claims team productivity from claims and adjudication automation.
| Claims Administration Issues in PACE | How PACEClaims Solves Them |
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Claims operations are tied to a single clinical system —
standalone, EHR-agnostic platform.
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PACEClaims runs independent of whatever EHR you use.
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Every claim requires a person to decide how it's handled.
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✓
PACEClaims' automated rules engine adjudicates routine claims without a person touching them.
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Pricing consistency depends on which examiner touches the claim —
automated Medicare and Medicaid pricing with configurable pricing rules.
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✓
PACEClaims automatically prices every claim the same way, every time.
No manual pricing, no inconsistency.
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Real exceptions get buried in manual queues.
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✓
PACEClaims automatically routes real exceptions out of the queue,
so they never wait behind routine claims.
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Proving how a claim was handled means reconstructing it after the fact —
complete claim history, audit trail, and decision visibility.
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✓
PACEClaims automatically documents every decision as it happens.
No reconstruction. Full transparency.
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Performance issues surface a month after they started.
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✓
PACEClaims automatically surfaces claims performance in real time.
No manual reporting, no waiting for a report.
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Every PACE organization runs by different rules, and generic claims
platforms force compromises.
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✓
Built-in automated pricers and configuration more than any system
built for this space.
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Four Outcomes. PACEClaims Delivers Choice.
Automate claims administration or use our TPA experts to manage it
EFFICIENCY
Process claims faster. Reduce administrative effort.
Intelligent automation reduces manual touchpoints, accelerates claims processing, and helps your organization handle growth without adding administrative complexity.
Faster claim resolution. Less administrative effort. More focus on participant care.
CONTROL
Know what’s happening with your claims—and your money.
Gain real-time visibility into claims activity, payment status, denials, exceptions, and financial performance to support better operational and reimbursement decisions.
Better financial oversight. Improved cash-flow visibility. Stronger management of claims outcomes.
TRANSPARENCY
One source of truth across your claims operation.
Bring claims, payments, providers, and vendors together so your team can find the information it needs without manual reconciliation or fragmented reporting.
Greater organizational visibility. Faster answers. More informed decisions.
Audit & Compliance
Ensure visibility and traceability across the claims lifecycle
Maintain visibility across the entire claims lifecycle—including decisions, payments, workflows, approvals, and supporting documentation.
Audit-ready records. Stronger compliance posture. Full confidence throughout the claims lifecycle.
See Claims Performance in Real Time
PACEClaims gives your team immediate visibility into the information that matters—from claim status and payment activity to exceptions, denials, decisions, and financial performance.
Instead of waiting for a report or reconstructing what happened, your team can see what is happening now and act accordingly.
What PACEClaims Users Are Saying
Ready to Rethink Claims Administration?
See how PACEClaims helps PACE organizations run a more efficient, financially controlled, and audit-ready claims operation — built around how you already operate.
