Provider Handbook

Provider Handbook

How to Work With Us

Our plan members are seen by their Primary Care/ Geriatricians (PCP) on site at Serenity Care PACE: 604 Cottage Street, Springfield, MA. 01104.

Once the PCP determines a need for specialty care, our staff will:

  • Call your office for an appointment for the participant.
  • Arrange for transportation to and from the appointment.
  • Provide translation during the appointment, in person.
  • Assure appropriate work up/ diagnostic testing is performed and communicated to your office prior to the appointment.
  • Send your office patient referral/ authorization with demographic and pertinent clinical information and requests will be sent to your office prior to the appointment.
PLEASE NOTE THAT ALL SPECIALTY SERVICES AND FOLLOW UP VISITS REQUIRE AUTHORIZATION.

In case the authorization is not submitted prior to the patient appointment, please check the authorization status by calling the Authorization hotline at (413) 241-6321.

How to Request Authorization

  • Please call the authorization hotline to request an authorization for services. The number is (413) 241- 6321.
  • You may be asked to leave a message. Please leave the best time for a returned call; all calls are returned within 24 hours.
  • Authorizations forms are completed by our authorization specialists.
    A verbal telephone confirmation is sufficient in case of urgency; however, the authorization must be obtained PRIOR to the patient’s appointment.

What We Request of You

  • PROVIDE ONLY THE CARE REQUESTED ON THE REFERRAL FORM
  • FAX, mail or send a secure email of your visit notes or requests authorization for further care.
  • Give any prescription needed to the members to bring back to Serenity Care PACE to fill or fax prescription to (413) 747-3979

Get Patient Information

  • Find essential coverage information on member’s ID card.
  • Check eligibility on the day of the service by calling our provider services at (413) 241-6321. Have member ID number ready.

How to Get Paid

  • SERENITY CARE PACE REPLACES MEDICARE AND MEDICAID COVERAGE
  • Please make sure you have sent your report/ notes of the member’s visit prior to submitting a claim (FAX /Mail/ secure email). Claims will not be paid without supporting documentation of the provided service/s.
  • Please bill Serenity Care PACE for authorized services provided. Claims should be completed as if billing Medicare (same claim requirements).
  • Serenity Care PACE can accept either paper (mail or FAX) or electronic claims.
  • Paper claims may be filed directly to PEAK TPA, P.O Box 21631, Eagan, MN 55121
  • Electronic submissions may be filed via EDI Payer ID: 27034
  • To get started or ask questions about submitting electronic claims, call us and ask to speak with the operations specialist

Important Documents

“I have worked with many PACE organizations, both as a pharmacy provider and in a consultant role, and have yet to experience a more competent or better organized program.

Serenity Care PACE is both abundantly and professionally staffed, facilitating the provision of compassionate geriatric care and superior services to an unparalleled variety of older adults.”

ERIC WAGMAN, RELIANT CARE SOLUTIONS

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