Case Study: Statewide Billing Agent Services for Consumer-Directed Programs

The Client:
State of New Jersey, Department of Health and Seniors Services (DHSS),Division of Aging and Community Services (DACS)

The Projects:
Statewide Billing Agent Services for Six Consumer-Directed Programs Administered by DHSS

The Challenge:

New Jersey DHSS administers the following consumer-directed programs:

1. Caregiver Assistance Program (CAP);
2. Adult Family Care (AFC);
3. Assisted Living Program (ALP);
4. Assisted Living Residence (ALR); Comprehensive Personal Care Home (CPCH); and,;
5. Jersey Assistance for Community Living (JACC).

These Medicaid and state-funded programs provide long-term services and supports for eligible individuals with disabilities and senior citizens to reside in the community asindependently as possible. In August of 2006, Public Partnerships, LLC (PPL) was awarded the contract to take over statewide billing agent and FEA services from another vendor. One of PPL's greatest assets to the program was the initial quality check and clean-up of the state's data and the initial and ongoing consulting to the state's authorization system. This required a re-design of significant portions of their system while in live production.

The PPL Approach:

Upon award of the contract by New Jersey DHSS, PPL implemented the following steps:

• Customized PPL information technology systems to meet unique requirements of six state programs;
• Collaborated with DHSS to implement enhancements to the existing participant and provider data base and service authorization system;
• Developed payroll systems and processes to support participant-employed providers (direct hires);
• Developed accounts receivable systems and processes to support participant co-payment requirements based on a sliding scale for the state-funded program (JACC);
• Established customer service capabilities within the PPL New Jersey Team in Chelsea, MA; and,
• Enforced complex program requirements based on applicable Federal and state regulations.

The Result:

• Seamless transition of approximately 4,500 participants from the incumbent vendor to PPL
• Provision of accounts payable services for approximately 250 agency providers
• Provision of payroll services for approximately 170 participant-employed providers
• Collection of co-pay requirements for over 700 JACC participants
• Development of effective statewide relations with Care Coordinators, Care Managers, and County Liaisons
• DHS was recently awarded a 3 year US Administration on Aging Grant for a unique program in Camden County to prevent nursing home placement; PPL will provide financial management service for their new program.