PCG specializes in designing and deploying creative systems and solutions which allow agencies to replace manual application review activities with data and analytics in order to enhance the integrity of public assistance membership files.
PCG currently processes more than 2 million benefits eligibility verification transactions every day on behalf of dozens of state health and human services agencies. Each transaction automates the comparison of data from one or more state, federal and/or commercial data sources with the applicant’s identity, attestations and program requirements to verify eligibility and flag any instances of potential fraud.
Our identity and eligibility verification data broker services include:
- Automated eligibility verification services
- CMS-compliant asset verification services (AVS)
- Benefits eligibility redetermination services
- Predictive analytics design services
- Eligibility verification web application development services
- Eligibility verification systems integration services
Data Broker Services
PCG maintains established APIs and ETLs with dozens of federal, state and commercial data sources via our enterprise-class data hub. On behalf of our agency customers, we serve as a “one stop shop” for managing the access to and integration of this data. Our data broker service is designed to establish a single API or batch interface between the agency and PCG’s data hub, allowing the agency to avoid developing and maintaining dozens of custom and costly connections with third party data sources.
Our data broker service includes defining a configurable rules engine to dictate what agency inputs and/or scenarios should result in the querying of which data sources, to be evaluated against which program limits and business rules, resulting in the generation of which custom outputs, extracts and/or on-screen reports.
Because we are data 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, comprehensive solution.
Eligibility Verification Services
PCG designs and integrates custom eligibility verification services for our agency customers that ensure: (1) the agency is connected with the critical federal, state and/or commercial data sources needed; (2) the agency can connect to this data in the most convenient manner possible, including via batch, API, or our stand-alone, web-based solutions; (3) this data is complemented with a configurable agency and program-specific analytics rules engine; and (4) the total solution maximizes the agency’s ability to expedite application processing timeframes and identify ineligibility and/or fraud.
Our eligibility verification services will automatically flag and verify some or all of the following criteria potentially impacting eligibility based on member-level program limits and requirements:
- Fraudulent Behavior
- Criminal History
- Credit History
- Unearned Income
- Earned Income
- Household Composition
- Undisclosed Earners
- Caretaker Relative Ages
- Self-Employment Income
- Undisclosed Income Sources
- New Hires
- Dependent Statuses
- Financial Assets
- Property Assets
- Motor Vehicles
- Undisclosed Bank Accounts
- Disqualifying Asset Transfers
- Undisclosed Property Ownership
- In-State Residency
- Out-of-State Benefits Eligibility
- Intentional Program Violations
- Lottery Winnings
- Child Support Participation
- Unemployment compensation
- Alien status
Asset Verification Services
PCG is the country’s most experienced Medicaid asset verification services (AVS) vendor. Since 2012, PCG has been engaged by dozens of states to implement and operate CMS-compliant asset verification services.
Our asset verification service connects agencies with 100 percent of the financial institutions in the United States to verify account ownership potentially impacting resource-based benefits eligibility. PCG’s asset verification services are designed to help our agency partners achieve the following goals: (1) eliminate the need for your workers to manually collect and review physical bank statements, except from those clients PCG identifies as exceeding program resource limits; (2) identify undisclosed bank accounts; (3) verify the account balances of disclosed bank accounts; (4) identify disqualifying asset transfers; and (5) flag the need for a client to spend-down assets before eligibility is approved.
Our asset verification services can be enhanced through the inclusion of not just financial assets potentially impacting eligibility, but also with real and personal property assets contributing to resource-based eligibility decision-making.
We offer agencies multiple options for accessing our AVS, including via batch file exchange or real-time web services calls or through our stand-alone AVS Web Portal, the country’s most used AVS software.