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, 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:

  • 索赔处理服务和解决方案
  • 咨询及谘询服务
  • 成本分配计划和时间研究
  • 成本结算及补充付款策略
  • 改革交付体系,进行绩效管理,提高质量
  • 健康信息技术(HIT)
  • Healthcare access and markets
  • 医疗补助管理要求
  • 医疗补助成本报告服务
  • 会员资格验证数据代理服务
  • 提供者管理和程序完整性
  • 费率设定和支持服务
  • 服务交付生命周期管理
  • 收入周期管理服务

 

Services include


索赔处理服务和解决方案


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:

 

谘询及谘询服务


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
  • 公众安全谘询服务

 

成本分配计划和时间研究


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.

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成本结算及补充支付策略


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.

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交付系统改革,绩效管理和质量改进


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.

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健康信息技术(HIT)


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.

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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. 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.

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医疗补助管理要求


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.

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公共援助资格数据管理服务


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
  • 使其更容易识别不合格和欺诈


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. 

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供应商管理和程序完整性


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.

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费率设置和支持服务


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:


服务交付生命周期管理


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. 

收入周期管理服务


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.



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