PACE Service Determination Requests with Salesforce

The Challenge

Coordinating an SDR means getting physicians, nurses, social workers, therapists, and the rest of the IDT on the same page, fast. Most teams do it with spreadsheets, sticky notes, and email.

Two Clocks, Eleven Disciplines

The first clock runs from the request to the IDT. The second runs from IDT receipt to the decision. Both are 3 calendar days. Managing them separately, for every request, across every participant, is a lot to hold in anyone's head...or spreadsheet.

Extensions With Strict Rules

Extensions are only allowed in specific situations, and the notice has its own 24-hour deadline. A missing or poorly documented extension carries the same risk as a missed clock.

Small Misses, Big Consequences

When a clock runs out, the request automatically converts into an adverse decision. That decision goes through the appeals process. Patterns of missed clocks show up in CMS and state audits and can lead to corrective action plans or even a hold on new enrollment.

No Way to Prove Timing

Manual tracking makes it hard to catch a clock before it expires. It's even harder to prove, after the fact, exactly when each clock started.

The Solution

We build an SDR process that starts the right clock at the right moment and keeps everyone accountable until the decision is made.

Automatic IDT Routing

A Health Cloud case captures each SDR at intake and routes it to all 11 required IDT roles immediately. The first clock starts automatically. Nobody has to remember to loop everyone in.

Dual Countdown Timers

Flow-driven timers track the request-to-IDT clock and the IDT-decision clock separately. As a deadline approaches, escalations go to IDT members and supervisors ahead of daily huddles, well before the end of the week.

Structured Decision Workflow

Approve, deny, and partial-deny decisions get captured with clinical rationale. Each decision has a time-stamped audit trail tied to the clock it satisfied.

Documented Extensions

When an extension is needed, the workflow captures the justification, whether the participant requested it or the team needs outside information. Notices are generated within the required 24-hour window.

Audit-Ready Dashboards

Compliance and operations leaders see SDR volume, turnaround against both clocks, and approval, denial, and extension rates in one place.

The Results

Every Clock Visible, Every Decision Documented

With SDRs running on Health Cloud, your IDT stops relying on memory and sticky notes. Every request reaches the full team the moment it's captured, and both clocks are visible to everyone who needs to act.

Escalations arrive early, while there's still time to make a decision. Extensions get the right justification and a notice on time. When a request does need extra attention, supervisors hear about it before the huddle, with time left on the clock.

Compliance teams benefit most. Dashboards show turnaround trends across both clocks, so leaders can fix a bottleneck before it becomes a pattern. And when auditors ask when a clock started, the answer takes seconds to find.

As your enrollment grows, the process scales with it.

Ready to Get Ahead of Every SDR Clock?

Your participants are counting on timely decisions, and your auditors are counting the days. Let's learn your current SDR process and talk through where automation would help most.