Overview

TMG HEALTH—YOUR PREMIER GOVERNMENT HEALTH PROGRAMS PARTNER

Medicaid Experience
For health plans engaged in the highly regulated, narrow margin Medicaid market, closely managing the details makes all the difference. TMG Health's government program experience and customized systems can help you handle the complexity of Medicaid plan administration in today's unprecedented regulatory and economic environment.

TMG Health understands Medicaid. We are an end-to-end Business Process Outsourcing (BPO) services provider delivering Medicaid member- and provider-centric solutions that are efficient, effective and compliant, and as a result, improve the experience for all customers - regulators included!

Our 10+ year history of experience working exclusively with government health plans gives us the unique insight and capabilities to support Medicaid Managed Care Organizations (MCOs) and Medicare Advantage Organizations (MAOs), and positions us to react quickly to future "safety net" (Expanded) plans as eligibility expands into the uninsured markets. We are focused on building and maintaining infrastructure (People, Processes and Technology) dedicated to handling the unique and ever-changing Medicaid and Medicare regulations, including those stemming from Healthcare Reform. We continue to make a significant investment in data warehousing, business intelligence (BI) and Medical Management (Utilization Management, Case Management, Disease Management) capabilities and tools that are available for our clients to also manage these concerns.

TMG Health provides the specialized Information Systems and automation required by state and federal contracts to enable eligibility verification; accurate enrollment and updates into the correct benefit package; claim administration; third party liability tracking, fraud and abuse investigation and reporting; and encounter reporting, including Risk Adjusted Rating analysis. We are HIPAA transaction and coding compliant. In addition, we offer support for pay-for-performance and demonstration initiatives in Medical Management, Quality Management and HEDIS reporting. Our state-of-the-art e-business systems allow your plan personnel to seamlessly continue local member customer service handling. We structure each solution to retain key client resources in support of Member and Provider Services (e.g., through the TMG Call Center) and Medical Management. TMG Health's suite of outsourcing solutions assures compliance with federal and state regulations and contractual performance requirements. Solutions can include, but are not limited to:

• Electronic(834) and paper enrollment and eligibility processing
• Electronic(837, NCPDP) and paper claim imaging, OCR, and adjudication
• Electronic and paper remits, and payments via checks or fund transfers
• Member panel and capitation management, including panel transfers
• Dual (Medicare/Medicaid) claims processing using external or internal crossover resources
• Member and Provider multilingual call center services
• Fulfillment services for welcome packets, ID cards, surveys, handbooks, regulatory and health campaign letters, etc.
• Premium billing and reconciliation
• Contractual data management and reporting, such as recovery efforts and success, medical management quality outcomes, pregnancy and death alerts, etc.
• Encounter filing, error management and correction, and analysis of outcomes.

Our scalable, flexible processes and systems, and the knowledge gained from implementing dozens of government-sponsored plans, combine to deliver rapid, stable, and successful plan launches, enabling continued growth and high levels of service.

Current Healthcare Reform lays out a national plan for covering Americans that has a major expansion of Medicaid eligibility as its cornerstone. Business will be "the same, but different." There will be a dramatic increase in the number of enrollees in Medicaid and/or Expanded Medicaid Managed Care, requiring new benefit configurations and processes. There will also be new enrollment and delivery models for MCOs to participate in, such as Exchanges and Accountable Care Organization models, and new models to serve dual eligibles. TMG will be there to help you adapt to these changes throughout the Healthcare Reform process and beyond.

Cost Optimization
TMG Health's cost-effective, service-oriented solutions allow you to minimize your capital investment; eliminate ongoing system costs and IT resource requirements; greatly reduce costs for acquiring, training and maintaining staff; and enjoy constant access to state-ofthe-art systems and best practices. We offer:

• Predictability, with costs guaranteed month over month. We can project Per Member Per Month fees with less than .75% fee charges due to change order requests.
• Flexibility to support multiple payment methodologies.
• The ability to support your enrollment, eligibility, and reconciliation processes.

Our comprehensive benefit package, Medical Management rules, and edit programs ensure that payment is made only for appropriate services. Encounter data rejections are eliminated, thereby maximizing Medicaid risk and performance payments from the state. TMG Health also provides comprehensive member demographic and health status information management via data warehousing and business intelligence to ensure correct rate-setting per recipient (for general rate-setting as well as risk-adjusted rates). This effort, coupled with your plan's mechanisms to manage provider contracts and utilization patterns (through data we can provide), goes a very long way in offsetting state reimbursement rates that often do not keep pace with medical trends.

Member-Sensitive
TMG Health shares your concern for the individual member. While we provide all of the BPO support that your plan needs to carry out your mission in the most responsive, cost-effective way, positioning your organization to meet the challenge of an expanded Medicaid membership under Healthcare Reform, we both know it is the customer experience that drives choice.

We are experienced in working with culturally diverse and challenged populations. We understand the access, lack of knowledge, fear, and disparity issues that contribute to non-compliant actions. We recognize the special needs of the most vulnerable population of the poor, young, elderly, disabled and chronically ill. We pride ourselves on responsiveness to member inquiries and requests for help, and partner with you to address your plan's specific concerns. It is this human touch, in addition to the timely production of member ID cards, HRAs and other materials, and member help "touch points" and proactive "reminders" of upcoming health needs and events, that distinguishes our service and your members' experience.

Provider-Friendly
TMG Health shares your commitment to your individual providers. We guarantee their satisfaction through:

• Timely and accurate provider setup, delivering speed-to-market for new entrants
• Accurate data for provider pay-for-performance/risk adjustment and reimbursement
• Timely and accurate claims payment, driving EFT (Electronic Funds Transfer)
• Fast, knowledgeable systems and/or staff response to provider inquiries and concerns
• Accessibility via our provider portal
• Mobile marketing and appointment reminders, medical updates by phone, etc.

In short, TMG Health improves plan performance and customer satisfaction, while enhancing revenue-generating opportunities. Contact us to learn how we can help your plan reduce administrative costs, become more efficient, and free your staff to concentrate on the member health side of your business.