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:

  • Claims processing services and solutions
  • Consulting and advisory services
  • Cost Allocation Plans and time studies
  • Cost settlement and supplemental payment strategies
  • Delivery system reform, performance management, and quality improvement
  • Health information technology (HIT)
  • Healthcare access and markets
  • Medicaid administrative claiming
  • Medicaid cost reporting services
  • Member eligibility verification data broker services
  • Provider management and program integrity
  • Rate setting and support services
  • Service delivery life cycle management
  • Revenue cycle management 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:

 

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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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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Public Assistance Eligibility Data Management Services


As the need for introducing automation into previously time-consuming public assistance application intake and eligibility determination processes continues to grow, state health and human services (HHS) agencies are increasingly required to establish, implement, and manage interfaces with dozens of disparately located federal, state, and commercial verification data sources.

PCG eliminates the time, resource requirements, and complexity of these tasks by:

  • Centralizing and managing HHS agency access to hundreds of third-party APIs and ETLs through a single PCG API Gateway
  • Automating real-time data exchanges through fully configurable multiplexer services and rules engines
  • Evaluating raw verification data against member-specific eligibility policy, known “problematic” applicant profiles, and predictive analytics
  • Returning consolidated, organized results to HHS agency systems via API, on-screen HTML reports, batch, and/or via stand-alone PCG Web interfaces


In short, PCG optimizes the management of third-party verification data to improve the efficiency and accuracy of public assistance eligibility decisions while eliminating the resource requirements, costs, and complexity associated with managing dozens of different third-party data interfaces at the same time.

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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.



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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