Run your whole PACE program from one participant record.
BTBCare brings your interdisciplinary team, the day center, the clinic, and home care onto one platform — individualized care plans, IDT assessments, eMAR, attendance, transportation, and claims — so coordination is shared, the service-determination clock is met, and audit readiness is something you run, not chase.
In BTBCare for PACE
- Individualized care plans (IPC / DHCS-0020) generated from the team's actual assessments, with reusable templates and copy-forward between care periods.
- Interdisciplinary assessments and IDT/MDT coordination with discipline-specific forms, required-role signatures, and a clear view of what's signed and what's outstanding.
- eMAR and medication management for a closed-loop record across the clinic and home care.
- Attendance and kiosk check-in that keeps daily census aligned with billing and the care plan.
- Billing and claims with EDI submission tied directly to attendance and delivered services.
- Treatment authorization tracking so service decisions and approvals stay on the record and on the clock.
Who champions it
PACE executive and clinical leadership — Executive Director, Medical Director, Director of Quality & Compliance, and Director of Clinical Operations — who own audit readiness, the capitated risk margin, and IDT performance.
Who uses it every day
The full interdisciplinary team that touches a participant every day: primary care physicians and nurse practitioners, RNs, social workers, PT/OT/recreational therapists, dietitians, the center director, home care and personal care coordinators, transportation coordinators, and the enrollment, intake, and billing staff who keep the program running.
What slows PACE teams down
Care lives in too many places — IDT notes in spreadsheets and email, assessments in one system, the care plan in another — so no one has a single, current picture of the participant.
Service determination requests stall against the 3-calendar-day clock because the request, the IDT discussion, and the decision aren't tracked in one place.
Pulling together a CMS or state readiness review means hunting for missing IDT signatures, attestations, and reassessment dates across disconnected files.
Coordinating 11 mandated disciplines around one participant — across the day center, clinic, and home — turns into manual follow-up instead of shared visibility.
Under a fully capitated, at-risk budget, leaders can't see medication, attendance, transportation, and claims data together to manage cost and quality.
Attendance and transportation are tracked by hand, so census, billing, and the daily ride schedule drift out of sync.
Medication management across the clinic and home care lacks a closed-loop record, raising both safety and audit risk.
Families and participants are left out of the loop, generating calls the team has to chase down between visits.
From a month-end scramble to a record that holds up
One participant record the whole IDT shares — assessments, the individualized care plan, medications, attendance, and transportation in the same place.
Service determinations, reassessments, and IDT sign-offs move on schedule, with a complete trail when reviewers come asking.
Audit and readiness reviews become a report you run, not a file hunt — every signature, attestation, and date is captured as work happens.
Tighter coordination across the day center, clinic, and home so changes in a participant's condition reach the right discipline fast.
Clearer line of sight on the capitated dollar, with medication, attendance, claims, and authorization data in one analytics view.
Cleaner claims and faster reimbursement through structured billing and EDI submission tied to real attendance and services.
Less manual re-keying for clinical and admin staff, so more of the day goes to participants instead of paperwork.
Families who feel informed and included, with fewer status calls for the team to return.
What you get
Individualized care plans (IPC / DHCS-0020) generated from the team's actual assessments, with reusable templates and copy-forward between care periods.
Interdisciplinary assessments and IDT/MDT coordination with discipline-specific forms, required-role signatures, and a clear view of what's signed and what's outstanding.
eMAR and medication management for a closed-loop record across the clinic and home care.
Attendance and kiosk check-in that keeps daily census aligned with billing and the care plan.
Billing and claims with EDI submission tied directly to attendance and delivered services.
Treatment authorization tracking so service decisions and approvals stay on the record and on the clock.
Transportation dispatch with participant mapping and driver assignment, integrated with the day center schedule.
Family and participant engagement so caregivers stay informed between visits.
Compliance and audit trail capturing every signature, change, and attestation as it happens.
Reporting and analytics across clinical, attendance, transportation, and claims data for both operations and the capitated budget.
Role-based access control with two-factor authentication and PHI encryption to protect the record.
Designed around the regulations you answer to
- Built around 42 CFR Part 460 — the interdisciplinary team as the core of care management and service delivery.
- Supports the service determination clock — requests brought to the IDT no later than 3 calendar days from the request.
- Helps track grievance and appeal timelines: 30 calendar days for standard cases and 72 hours for expedited appeals.
- Captures the required-role IDT signatures and discipline-specific assessment documentation reviewers expect.
- Tamper-evident audit trail with role-based access, two-factor authentication, and AES-256 PHI encryption to support CMS and state readiness reviews.
PACE, answered
How does BTBCare support the PACE interdisciplinary team model?
Every discipline on your IDT works from the same participant record. Assessments, the individualized care plan, medications, attendance, and transportation live in one place, and discipline-specific forms with required-role signatures make it clear what's been completed and what's still outstanding — so coordination across the day center, clinic, and home is shared rather than chased through email and spreadsheets.
Will BTBCare help us stay audit- and readiness-ready under 42 CFR Part 460?
That's the design goal. The platform captures IDT signatures, attestations, assessment documentation, and care-plan changes as the work happens, all behind a tamper-evident audit trail with role-based access, two-factor authentication, and PHI encryption. When a CMS or state review comes, readiness is a report you run instead of a file hunt across disconnected systems.
Can it keep us on the service-determination and appeals timelines?
Yes. Service determination requests, treatment authorizations, and IDT decisions are tracked in one place with their dates, so the request reaches the team within the 3-calendar-day window and you can keep sight of the 30-day grievance and appeal clocks and the 72-hour expedited-appeal deadline. The record shows what was decided, by whom, and when.
How does BTBCare handle the capitated, at-risk side of PACE?
Because attendance, medications, transportation, authorizations, and claims all sit on the same platform, your leadership can see clinical and operational data together instead of stitching it from separate systems. Billing and EDI claims tie directly to real attendance and delivered services, supporting cleaner reimbursement and a clearer view of cost and quality under your capitation budget.
Does it cover the day-center, clinic, and home-care sides of our program?
It's built for all three. Kiosk check-in and attendance keep the day-center census aligned with billing and the care plan, eMAR provides a closed-loop medication record across the clinic and home, and transportation dispatch with participant mapping and driver assignment keeps the daily ride schedule connected to the rest of the operation.
Other care settings
Bring BTBCare to your pace program
A 30-minute walkthrough, mapped to your care setting. No pressure — just a look at the plan, the team, and the claim on one record.