At PCG, we understand the challenges state Medicaid agencies are up against. Tight budgets, limited staff, 而缺乏高质量的数据会妨碍你的效率, cost-effectiveness, 以及获得最佳结果的能力.
PCG can help. 我们随时与全国30多个医疗补助机构合作, so we understand what does and doesn’t work—insights we will share with you. Our team has proven processes, systems, databases, 以及为你的州准备好的解决方案, including:
- Healthcare access and markets
PCG provides a variety of claims processing services and solutions on behalf of state agencies and payers. 与全国各地的机构合作, 我们发展了创新和高效的运营模式, as well as technological tools that we deploy on behalf of our clients to perform these important business functions at a competitive cost. 通过委托我们执行这些服务, our clients are able to focus on more important and strategic program functions and responsibilities. Our services include:
我们提供广泛的支持, training, and expertise to help you improve your agency’s operations and performance, 根据您的需要提供咨询服务, including:
- Provider training
- Business process redesign
- Policy & advisory
- Monitoring & reporting
- Data analytics
- Quality & outcome measures
PCG specializes in public assistance cost allocation plans and indirect cost rates for agencies that seek reimbursement from federal programs. 我们在统一管理要求方面有专业知识, 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.
Medicaid agencies and public providers are critical to the safety net system of care. 确保他们有必要的资源来提供安全网, 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:
COVID-19 Pandemic Response Management Contact Tracing, Case Investigation, & Exposure Notification
PCG has onboarded more than 10,000 contact tracing staff in multiple states across the U.S. and offers the expertise to immediately launch this scalable solution to meet the needs of your state or community. 我们是在经验的基础上开展这项工作的. In the past five years, 在COVID-19大流行之前, we completed 125,000 +医疗调查, reviews, and training sessions.
PCG为日博网站医疗保健客户提供服务体系改革, 质量和性能改进, and other technical advisory services related to state health reform efforts. Our clients range from Medicaid agencies, to hospital systems, to community based providers.
Our 健康信息技术(HIT) team works with state and government agencies, with a focus on Medicaid, 交流和卫生信息技术, to help further the advancement of technology in the world of health care.
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. 这包括身体和行为上的医疗保健. States turn to PCG to organize their commercial health insurance regulatory compliance.
PCG works with agencies to administer standalone 医疗补助管理要求 programs in addition to claiming efforts that are part of wider cost allocation plans.
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, 联邦和商业来源与先进的预测分析:
- Accurately flag ineligibility at application and between application and renewal
- Expedite eligibility determinations and automate eligibility redeterminations
日博网站服务是可持续的和可扩展的, and it gets results: States using PCG’s member eligibility verification services identify between 5 – 15% of their membership as potentially ineligible, 平均每100人每年可以节省3000万美元的成本,000应用程序/更新处理.
PCG's innovative approach to Provide Management and Payment Integrity is specifically designed with Medicaid and HCBS / LTSS services in mind. 日博网站方法是上游的，主动的，快速的，灵活的. 面向责任和可量化的未来成本避免, 我们展示了比缓慢行动更大的好处, large-scale, 长期审计只着眼于补偿.
PCG是医疗补助计划值得信赖的合作伙伴, 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, 例如不成比例共享医院(DSH)付款, 最高付款限额计算, and provider assessments. 我们不仅帮助机构建立和重新校准比率, we also work with our clients to engage stakeholders and inform the provider community on changes to rates, 以促进透明度和建立共识. Our services include:
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, 继续通过服务授权和服务交付, 并以可靠的付款方式结束.
PCG has been working with public and other providers to maximize revenue streams to ensure the sustainability of services and programs. 日博网站工作包括外包账单服务, 落后的账单服务，以优化收入收集, coding services, 法规遵循和审查服务, 以及收入周期管理评估和培训服务. 我们有各种各样的计费解决方案来处理制度, professional, and pharmaceutical claims.
PCG专有的基于网络的成本分摊工具， 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. 它已经在全国各地的机构实施.
AlloTrac™ - 100% Time Tracking Systems
PCG专有的基于网络的成本跟踪工具， 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. 结果被用来分配参与工人的成本.
PCG基于网络的随机时刻采样软件， 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. 该结果用于分配抽样工人的成本.