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


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. PCG has 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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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)


Within the PCG Health practice area, the 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. PCG offers 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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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. 

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.

Learn more