In an uncertain economy, every dollar counts. Is your organization optimizing reimbursement for newborn screening services?

 

Public Consulting Group (PCG) is a recognized leader in medical billing and collection services for public and private sector health and human services facilities. We annually process more than 700,000 newborn screening laboratory services to third party health plans, including Medicaid. Let us help you.

State Laboratories and Newborn Screening Programs

Every state routinely performs newborn screening tests for more than 50 metabolic, genetic, and infectious diseases. With more than 4,000,000 births annually in the United States, early detection and treatment can lead to significant reductions of death, disease, and associated disabilities. State laws mandate routine testing for newborns within 24 hours of birth, while some states mandate a second screening for every newborn.

 

Many private health plans and state Medicaid programs will reimburse the state laboratory for performing newborn screening panels. However, many state laboratories and newborn screening programs are often not equipped to efficiently submit claims and effectively collect reimbursement.

PCG Health's Newborn Screening Medicaid and Third Party Billing Services Include

Public Consulting Group (PCG) has nearly 25 years of experience with and knowledge of managed care and Medicaid reimbursement methodologies and claims operations, giving us the flexibility to customize our approach based on the needs and requirements of each client. Our third party billing services include

Enhanced Data Matching

In many cases, data required for newborn screening claim submission is incomplete. PCG employs multiple methodologies to identify required data elements, resulting in more accurate newborn and parent information. This greatly improves the chances of obtaining accurate insurance information.

Insurance Verification and Eligibility Matching

PCG uses HIPAA compliant 270 and 271 transactions to perform patient insurance verification and eligibility matching prior to submitting claims to third party payers.

Electronic Third Party Claims Submissions

PCG submits claims electronically to third party payers, including Medicaid, using the HIPAA compliant 837 format. Claims go through a pre-submission scrubbing process and are rejected if specified claiming rules are not met. Rejections are routed to a billing specialist and corrected for submission.

Hospital Billing

Hospitals often bill health plans for testing and receive reimbursement direct from the payer. The laboratory incurs the expense of performing the test and invoices the hospital for reimbursement. PCG’s internal claiming system can generate monthly invoices and statements to accommodate this type of billing.

Payment Posting and Reconciliation

PCG applies various checks and balances to ensure accurate payment and denial posting. Our claim system accepts electronic payment files in the HIPAA compliant 835 format and payment data is posted automatically. We also employ an experienced staff for manually posting non electronic payments and denials. All payment data is reconciled to daily receipts and bank deposits to ensure payments are accurately posted.

Payer Reimbursement Monitoring

PCG performs routine payer reimbursement reviews to monitor and track appropriate reimbursement levels. These reviews allow us to take further action when necessary.

Denial Management and Claim Follow-up

Our approach focuses on continued analysis of claim rejections and denial reasons. We monitor trends and, when necessary, implement corrective actions to help lower and prevent rejections and denials.

Reporting and Analysis

Public Consulting Group has vast experience and knowledge in creating reporting solutions to assist client management with analyzing several key areas of operations, including routine operation status reports, volume and claim submission trends, and payment and denial trends. PCG develops and customizes reports to meet the specific needs of our clients.

Benefits of Our Services

PCG is a recognized leader in medical billing and collections services for public and private sector clients. We annually process more than 700,000 newborn screening laboratory services and 3,000,000 medically-related services to third party health plans, including Medicaid. Our services can help you:

  • generate significant additional revenue for state laboratories and newborn screening programs;
  • process claims faster to increase program cash flow;
  • significantly increase the number of claims billed.

Ask us about our newborn screening third party billing services for

  • State of Florida Department of Health, Bureau of Laboratories
  • State of Louisiana Department of Health and Hospitals, Office of Public Health

    For more information on how PCG can help your organization optimize reimbursement, contact us today.

 

Making a Difference in Student Achievement Using the Common Core State Standards for English Language Arts
Download the Newborn Screening Medicaid and Third Party Billing Services Datasheet

If you would like a printable copy of this information please download our datasheet.

 

Learn More

More Information

For more information about PCG Health's Newborn Screening Medicaid and Third Party Billing Services please contact us at info@publicconsultinggroup.com or 1-800-210-6113.