PCG’s scalable and customizable member eligibility verification data broker service gives our clients automated access to dozens of critical commercial, federal, financial and state eligibility verification data sources which can be used in concert with PCG’s predictive analytics to automate and expedite Medicaid, SNAP and TANF eligibility decisions while enhancing your agency’s ability to identify ineligibility and/or fraud.

 

Because PCG is vendor-neutral, we are able to offer the most comprehensive menu of identity and eligibility verification data sources from competing commercial vendors in a single solution which our agency clients can use to more accurately verify eligibility, detect fraud and expedite eligibility determinations. PCG uses this data to verify all of the following applicant/beneficiary identity and eligibility criteria:

  • Fraud, identity, credit history, citizenship, death, incarceration, credit; and criminal record;
  • Changes in household composition, undisclosed earners at address, caretaker relative age, marriage, divorce, dependents, and death;
  • In-state residency and out-of-state benefits eligibility;
  • Countable income, unearned income, self-employment income, and undisclosed income sources;
  • Countable assets, undisclosed bank accounts, significant account balance decreases; and
  • Countable property, undisclosed property, and disqualifying asset transfers.

Because PCG has already developed these APIs, agencies can save both time and money accessing some or all of this data from PCG’s data hub, rather than paying a vendor to spend 6-12 months setting up new interfaces and a supporting data warehouse. Having PCG, rather than the agency, manage this data and these interfaces, allows agencies to maintain only a single plug into PCG while PCG manages the time and effort necessary to maintain dozens of systems, APIs, and other connections between each data source.

 

Member Eligibility Systems and Services

 

PCG’s member eligibility verification data broker service can reduce worker time spent on each eligibility determination from hours to just minutes by automating access to critical verification data, automating the comparison of this data with program limits and requirements, and automating the identification of any risk of ineligibility and/or fraud, as follows:

 

  1. Agency sends PCG applications or renewals via either batch files, web services calls, and/or as ad hoc requests within PCG’s web-based eligibility verification system;
  2. PCG queries client-selected commercial, federal, and/or state data sources and obtains data supporting eligibility or ineligibility decisions;
  3. PCG performs 500+ data matches comparing data results to program limits and requirements and applicant attestations; and
  4. PCG sends responses to Agency via either batch file, web services and/or within our web-based eligibility verification system. Responses either confirm eligibility or identify areas of ineligibility risk, either of which will include all supporting data and source information.

Sample of Potentially Available Member Eligiblity Verification Data Sources

  • Commercial: Experian Credit, Income, and Fraud Shield; LexisNexis Identity, Property, Motor Vehicle, Residency, Criminal History, and Undisclosed Earner; Equifax Income and Employment; TransUnion Residency, Credit, Employment and Fraud; Accuity Financial Institutions and Assets; NADA Vehicle Values, and more.
  • Federal: DHS SAVE, SSA Death Master; SSA BEERS; SSA PUPS; National Directory of New Hires; PARIS; IRS DIFSLA; eDRS SNAP Disqualification, and more.
  • State: Unemployment; Child Support; DMV; Vital Statistics; Lottery Commission; Sex Offendor Registry; Public Employee Retirement System, Department of Corrections, Department of Public Safety, and more.

Asset Verification Services (AVS)

The availability of enhanced, 75 to 90 percent federal financial participation for asset verification enhancements (CMS–2346–F), combined with new verification requirements included in the Affordable Care Act and Section 1940 of the Social Security Act, make this the right time for the states to prioritize the automation of asset verification (AVS) at both application and recertification to determine benefits eligibility. Introducing electronic, automated asset verification will not only reduce enrollment levels by discovering ineligible and/or fraudulent applicants and beneficiaries, but it will also increase worker productivity through the introduction of automation into the eligibility determination process.

 

Public Consulting Group is the nation’s leading asset verification services firm having been engaged by more than a dozen state health and human services agencies to integrate financial institution and property data from the world’s leading data sources in order to enhance and expedite eligibility determinations.

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More Information

For more information about PCG's Member Eligibility Systems and Services services please contact us at
info@publicconsultinggroup.com or 1-800-210-6113.