www.publicpartnerships.com

case study:

Third Party Administration Services for a State
Program in Ohio

THE PPL APPROACH...
Upcoming SlideShare
Loading in …5
×

PCG Public Partnerships Case Study, Ohio Department of Health (ODH)

165 views

Published on

Case study released by PCG Public Partnerships for Ohio Department of Health (ODH).

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
165
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

PCG Public Partnerships Case Study, Ohio Department of Health (ODH)

  1. 1. www.publicpartnerships.com case study: Third Party Administration Services for a State Program in Ohio THE PPL APPROACH Upon award of the contract, PPL • Confirmed business requirements and developed program rules; • Customized information technology systems, including PPL’s Web Portal, to meet program requirements; • Developed a cost center budgeting tool to support ODH in allocation and reallocation of HIV/AIDS funds across service categories and regions of the state; THE CLIENT Ohio Department of Health (ODH) THE PROJECT Third party administration and financial management services for the Ryan White HIV/AIDS Treatment Extension Act of 2009 Part B Program. • Configured claims processing systems to pay service providers based on UCR (Usual, Customary, and Reasonable) rates, CPT (Customary Procedure Terminology) codes, and ADA (American Dental Association) codes; • Created flexible service rules allowing ODH the ability to close or expand service categories, helping the state to prioritize services to manage budget constraints; • Established automated tools to interface with the state Case Management Information System (CMIS), including electronic data transfer file protocols to exchange authorization and payment data; THE OPPORTUNITY ODH administers the Ryan White Part B Program, a statewide program serving more than 5,000 low-income persons with HIV/AIDS eligible for the Ohio HIV/AIDS Drug Assistance Program (OHDAP); the Health Insurance Premium Payment Program (HIPP); and the Medicaid Spend Down Payment Program (MSDP). This program provides reimbursement to providers of HIV/AIDS-related services who serve eligible participants, including diagnostics and monitoring, drug therapy, dental services, nutrition services, Medicaid spend down payments, health insurance premium payments, and emergency financial assistance. In March, 2010, PCG Public Partnerships, LLC (PPL) was awarded a threeyear contract to replace third party administrator services from another vendor. This opened up a new opportunity for PPL to perform third party administration and expand our Web Portal capabilities based on unique client needs. • Implemented security and privacy safeguards to ensure integrity of protected health information; and, • Established statewide customer service capabilities with qualified representatives to respond to provider inquiries. THE RESULT • Successful processing and payment of over $5 million in Ryan White HIV/AIDS funds to over 5,000 eligible individuals annually; • Improved ability of ODH to manage and monitor statewide expenditures; and • Increased frequency of provider payment for priority and emergency services, decreasing potential opportunities for gaps in delivery of essential health-related goods and services. PCG Public Partnerships, LLC | 148 State Street, Tenth Floor, Boston, Massachusetts 02109 | tel: (855) 243-8775 fax: (617) 717-0085 Copyright Public Consulting Group, Inc.

×