Solution | Eligibility Predictive Aggregate Analytical Solution 

PCG’s services include consulting, business process outsourcing, and specialized products and technology-enabled solutions in the health and human service sector. States contract with PCG to manage state SSI and SSDI benefit application processes. A major challenge facing PCG is the efficient and accurate identification of high-potential SSI and SSDI applicants from a large pool of potential applicants. PCG outsources data management and analytical services to meet this challenge.

As a proof of concept, NTELX provided PCG with a fully functional eligibility-based predictive aggregate analytical solution directed to foster-care children’s Title XVI Social Security Disability Income (SSDI) eligibility in support of PCG’s contract with the state of Illinois. The eligibility-based predictive aggregate analytical solution “predicts” SSI eligibility. The SSI model is a multi-tiered, hierarchal, rules-driven analytical engine. The NTELX methodology involves modeling the SSI application process in the context of the SSA regulatory environment, integrating the model into the system, automating the system, and developing a user interface and reporting capability.

PCG contracted with NTELX to provide the data management and analytical services in support of its existing contracts in its health and human services practice. Through its industry-leading solutions-driven thinking capability and professional expertise in the analytical and healthcare spaces, NTELX is also a valuable partner with PCG in identifying and developing opportunities in the healthcare space. NTELX works with PCG to implement a holistic approach to complex decision analytics that:

(1) links together both Medicaid and human services agency utilization data in order to produce a full picture of all of the health and human services;
(2) monitors, analyzes, and manages key performance indicators; and
(3) plans, analyzes, and researches platforms to support client agency programs, policies, and initiatives to improve the quality of organizational performance and work processes.

NTELX’s predictive analytical system drove a substantial increase in PCG processing efficiency and application acceptance rates. In doing so, NTELX analyzed more than 300,000 eligible members and 200,000 providers across about 5 million combined Medicare and Medicaid claims for two states. Of the eligible members, the NTELX system accurately pinpointed the top 2% most highly eligible candidates along with another 15-20% highly eligible candidates.