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 accounting and cost allocation plans
  • Financial management
  • Health care reform (HBE/HIX)
  • Managed care contracting and oversight
  • 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


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. 

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

 

Identity and Eligibility Verification Data Broker Service


Ensuring the integrity of your Medicaid membership files is essential. PCG offers an industry-leading approach to identity and eligibility verification that incorporates hundreds of data matches and advanced predictive analytics that:

  • Expedites eligibility determinations
  • Automates eligibility redeterminations
  • Makes it easier to identify ineligibility and fraud

 

Our service is sustainable and scalable, and it gets results: States using PCG’s Data Broker Service have realized a $34.4 million in cost savings per 100,000 applications/renewals processed. 

Behavioral Health


PCG helps state and local governments develop, improve, and refine their system of services for individuals with mental health and substance abuse challenges and individuals with developmental disabilities. Behavioral Health services include CAP, cost reporting, Medicaid rebalancing, prepayment review services, quality management, rate setting, revenue enhancement, strategic planning, and waiver design and management.

 

Related Products


AlloCAP - Cost Allocation Plans


With our AlloCAP™ web-based software system, PCG works with agencies to streamline and/or automate their existing cost allocation plans.

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AlloTrac - 100% Time Tracking Systems


100% Time Tracking is becoming the national standard for the allocation and reimbursement of small pools of staff across the public sector. We can help you maximize the recovery of funds and ensure compliance with federal and state regulations regarding the operation of time tracking systems.

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EasyRMTS - Random Moment Time Studies


PCG’s expertise can be leveraged to ensure compliance measures, maximum recovery of all available federal funds, and to ensure that documentation and training procedures are in place. Whether you are in need of a quarterly Random Moment Time Study in the area of child welfare or school-based medical services, or you need a time-limited time study for rate setting purposes, PCG can help.

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