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.
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.
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
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.
PCG uses HIPAA compliant 270 and 271 transactions to perform patient insurance verification and eligibility matching prior to submitting claims to third party payers.
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.
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.
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.
PCG performs routine payer reimbursement reviews to monitor and track appropriate reimbursement levels. These reviews allow us to take further action when necessary.
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.
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.
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:
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For more information about PCG Health's Newborn Screening Medicaid and Third Party Billing Services please contact us at firstname.lastname@example.org or 1-800-210-6113.