Overview
TMG Health supports well over two million members in government-sponsored plans for health insurers of all sizes, nationwide. Primarily serving Medicare members, TMG provides a full array of core administrative services and IT system components. Our primary functionality includes:
- Enrollment Processing
- Application form processing and/or data file intake
- Eligibility Maintenance
- Premium Billing
- Vast experience in statement and electronic billing, receipts posting management and delinquency processing. Detailed financial reporting for clients.
- Claims Payment
- Highly sophisticated claims payment system with national connectivity for electronic Medicare claims intake
- Call Services
- Large scale, multi-center call servicing for all types of member and provider inquiries as well as outbound calls.
- Print/Mail Fulfillment
- High volume, CMS and SAS 70 compliant, health-insurance-focused fulfillment operations handling daily routine correspondence and large format booklets.
Whether receiving crossover claims electronically from Carriers and Intermediaries (AB MACs), configuring numerous benefits or performing member retention outreach, TMG Health has leading edge systems, skilled staff and tested implementation/conversion resources to handle plans ranging from tens to hundreds of thousands of members and all Medicare Supplement plan types.
TMG Health is well versed in Compliance at the Federal and State level. We play a key role in advising and providing data for our clients during numerous CMS and other regulatory audits annually. Our experience in this area adds significant value to the services we perform on behalf of client plans - positioning TMG as a true partner in guiding our client's ongoing success in an era of increasing government scrutiny. In this same area, TMG also provides clients with the means needed to clearly monitor our services, facilitating their responsibility to perform proper vendor oversight.
In order to provide our client plans with the highest levels of system performance and security, TMG supplies highly contemporary IT infrastructure housed in redundant (2012) Tier 4 data centers. Our investment in this level of protection and continuity, coupled with our IS development capabilities are representative of our commitment to serve plans with the highest levels of service expectations.
Important in the ever changing landscape of health insurance, TMG Health's broad product portfolio and experience also serves our clients as a ready resource enabling rapid entry to new lines of business. These include managed Medicaid, Medicare Advantage, Part D Drug Plans or participation in the evolving realm of Exchange-based plans.
As the plans of today and tomorrow continue to evolve away from yesterday's admin-heavy internal operating model, TMG Health offers a proven, highly qualified source of technology enabled services making it possible for plans to better focus on the ever-more important tasks of care quality, member retention and revenue enhancement.
