For State Health & Medicaid Agencies

State Health & Medicaid Agencies

At PCG, we understand the challenges state Medicaid agencies are up against. Tight budgets, limited staff, and a lack of quality data can hamper your efficiency, cost-effectiveness, and ability to achieve the best outcomes. 

PCG can help. We work with 30 or more Medicaid agencies nationwide at any given time, so we understand what does and doesn’t work—insights we will share with you. Our team has proven processes, systems, databases, and solutions ready to put to work for your state, including:

  • Billing services
  • Business process redesign
  • Compliance and oversight
  • Cost allocation and time studies
  • Financial management
  • Health care reform (HBE/HIX)
  • Managed care contracting and oversight
  • Medicaid administrative claiming
  • Medicaid Management Information Systems (MMIS) and Title XIX eligibility systems
  • Member eligibility
  • Operations outsourcing
  • Payment and reimbursement reform
  • Program integrity / fraud and abuse
  • State Medicaid rebalancing services

 

Services include


Claims Processing Services and Solutions


PCG provides a variety of claims processing services and solutions on behalf of state agencies and payers. Working with agencies across the country, we have developed innovative and efficient operational models, as well as technological tools that we deploy on behalf of our clients to perform these important business functions at a competitive cost. By entrusting us to perform these services, our clients are able to focus on more important and strategic program functions and responsibilities.  Our services include:

 

Consulting and Advisory Services


We provide a wide range of support, training, and expertise to help you improve your agency’s operations and performance, with consulting services tailored to your needs, including:

  • Provider training
  • Business process redesign
  • Policy & advisory
  • Monitoring & reporting
  • Data analytics
  • Quality & outcome measures

 

Cost Allocation Plans and Time Studies


PCG specializes in public assistance cost allocation plans and indirect cost rates for agencies that seek reimbursement from federal programs. We have expertise within the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (2 CFR Part 200); 45 CFR 95.507-515; and various programmatic requirements that impact cost allocation and administrative claiming.

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Cost Settlement and Supplemental Payment Strategies


Medicaid agencies and public providers are critical to the safety net system of care.  To ensure they have the resources needed to provide that safety net, PCG has worked with Medicaid agencies and public providers across the country to optimize Medicaid funding streams through cost settlement and supplemental payment strategies. Our work has covered a broad spectrum of institutional and community-based providers, as well as the introduction of proprietary web-based cost reporting tools to support millions of Medicaid supplemental payments each year. Our services include:

 

Delivery System Reform, Performance Management, And Quality Improvement


PCG provides our health care customers with delivery system reform, quality and performance improvement, and other technical advisory services related to state health reform efforts. Our clients range from Medicaid agencies, to hospital systems, to community based providers.

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Health Information Technology (HIT)


Our Health Information Technology (HIT) team works with state and government agencies, with a focus on Medicaid, Exchanges and health information technology, to help further the advancement of technology in the world of health care.

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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.

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Identity and Eligibility Verification Data Broker Service


Ensuring the integrity of your Medicaid, SNAP, and TANF membership files is essential. We offer an industry-leading approach to benefits eligibility verification that combines data from dozens of state, federal and commercial sources with advanced predictive analytics to:

  • Expedite eligibility determinations
  • Automate eligibility redeterminations
  • Make it easier to identify ineligibility and fraud


Our service is sustainable and scalable, and it gets results: States using PCG’s Data Broker Service identify between 5 – 15% of their membership as potentially ineligible, resulting in an average of $30 million in cost savings per year per 100,000 applications/renewals processed. 

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Medicaid Administrative Claiming


PCG works with agencies to administer standalone Medicaid administrative claiming programs in addition to claiming efforts that are part of wider cost allocation plans.

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Medicaid Cost Reporting Services


Since our inception more than 30 years ago, PCG has worked with state agencies and public providers to complete Medicare cost reporting requirements. We will ensure that these important reports maximize revenue streams, provide information on the true cost of operations, and adhere to federal reporting requirements.


Provider Management and Program Integrity


PCG's innovative approach to Provide Management and Payment Integrity is specifically designed with Medicaid and HCBS / LTSS services in mind. Our approach is upstream, proactive, quick, and nimble.  Geared toward accountability and quantifiable future cost avoidance, we demonstrate bigger benefits than slow-moving, large-scale, long-term audits geared only toward recoupments.

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Rate Setting and Support Services


PCG serves as a trusted partner to Medicaid, public health, behavioral health, and other state agencies and payers to establish payment rates for services, including setting rates for both institutional and community-based services. Furthermore, we have helped states work through other rate setting and payment related issues, such as Disproportionate Share Hospital (DSH) payments, upper payment limit calculations, and provider assessments. Not only do we help agencies establish and recalibrate rates, we also work with our clients to engage stakeholders and inform the provider community on changes to rates, in order to promote transparency and build consensus. Our services include:


Service Delivery Lifecycle Management


PCG can help ensure the compliance and integrity of your entire service delivery lifecycle, using a comprehensive approach that starts at the point of provider enrollment, continues through service authorization and service delivery, and ends in a reliable payment. 

Revenue Cycle Management Services


PCG has been working with public and other providers to maximize revenue streams to ensure the sustainability of services and programs. Our work includes outsourced billing services, come-behind billing services to optimize revenue collections, coding services, compliance and review services, and revenue cycle management assessment and training services. We have a variety of billing solutions to process institutional, professional, and pharmaceutical claims.  

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Related Products


AlloCAP - Cost Allocation Plan Software


PCG’s proprietary web-based cost allocation tool, AlloCAP imports agency financial and statistical information and performs cost allocations in accordance with an agency cost allocation plan. It allocates costs to benefiting programs and produces reports that show the true costs of operating programs and are used to claim administrative costs. It has been implemented by agencies across the country.

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AlloTrac - 100% Time Tracking Systems


PCG’s proprietary web-based cost tracking tool, AlloTrac is used to track the time of a group of workers where random moment sampling is not feasible. It allows workers to track their time according to specified activities in specified increments. The results are used to allocate the costs of the participating workers.

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EasyRMTS - Random Moment Sampling Software


PCG’s web-based random moment sampling software, EasyRMTS is a proprietary web-based random moment sampling tool that is used to conduct statistically valid random moment time studies (RMTS) of a group of workers. It assigns a user-determined amount of surveys to a group of workers and administers the surveys via email over a sample period. The results are used to allocate the costs of the sampled workers.

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