For Health Plans

Health Plans

Managed care plans are under more regulatory scrutiny than ever before. Meanwhile, they face the business challenge of controlling Medicaid costs without sacrificing patient outcomes. At PCG, we’ve worked in the Medicaid program integrity environment for more than three decades. Our team will work with you to better define quality and system goals and develop compliance and outcomes measures to optimize your plan’s performance.

Services include


  • Compliance Consulting
  • Network Provider Screening, Enrollment, and Management
  • Pre-Payment Claims and Case File Reviews
  • Post-Payment Reviews and Investigations
  • TPA

 

Healthcare Access and Markets


States regulate their private insurance markets and operate Medicaid managed care and fee-for-service programs to assure healthcare access to residents. This includes access to both physical and behavioral healthcare. States turn to PCG to organize their commercial health insurance regulatory compliance.

Learn more