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Third Party Administration

Our client-tailored third party administration (TPA) service, PeakTPATM, offers expertise in health plan management to help healthcare organizations stay focused on care delivery. We submit data both to the Centers for Medicare and Medicaid services (CMS) and many State Administering Agencies (SAAs) for accurate reimbursement.

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Customized TPA from experts

We offer TPA services for Programs of All-Inclusive Care for the Elderly (PACE) and other value-based care organizations.

Tailored to your organization

Superior customer service

Highly experienced staff

We are an NPA Shared Services Provider

Feel confident with our National PACE Association (NPA) membership, which ensures PACE-tailored services for increased quality and efficiency at a fair price.

Optimized capabilities

PeakTPA includes a full suite of management services. Our extensive experience with TPA allows organizations to focus on providing care instead of the technicalities of a health plan.

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  • Encounter data processing and submission: Encounter data submitted to CMS based on claims received electronically or on paper
  • Claims adjudication: Expense reports related to monthly claims organized by service and specialty for adjudication, processing, and payment
  • Enrollment management/ billing/ reconciliation: CMS submissions based on state and county code, institution, and end-stage renal disease (ESRD) and Part D status.
  • Accounts receivable: Medicare and Medicaid revenue and payments by participant and payer for distribution and provides all related journal entries
  • Risk adjustment data submission: Risk adjustment data submitted to CMS based on claims and encounters received, and error follow-up and correction
  • Reporting: Helpful insights regarding PACE performance available to print upon request
  • Implementation: A 6- to 8-week implementation plan that includes a weekly staff call to ensure a smooth transition
  • Coordination of benefits/Medicare Secondary Payer (MSP): Data submitted for the Electronic Correspondence Referral System and the annual MSP survey

Billing resources

  • Institutional billing guidelines: The National Uniform Billing Committee (NUBC) maintains a single billing form and standard data sets for private and public institutional providers and payers nationwide. Download the PDF >>
  • Professional billing guidelines: The National Uniform Claim Committee (NUCC) promotes national standards for the processing and submission of standardized and non-standardized professional claims. Download the PDF >>

  • General billing guidelines:

Other resources

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