Premium Billing
PREMIUM BILLING AND DELINQUENCY PROCESSING
Premium billing drives both revenue as well as the member’s perception of their Health Plan. Errors or delays in premium billing affect cash flow and member satisfaction. The TMG Health premium billing process (TMG Bill) is managed in accordance with our clients’ policies and procedures and meets all Medicare and Medicaid regulations. TMG Health handles the full Premium Billing process from billing paper and electronic invoicing to receipt of payments from SSA, via ACH and lockbox.
Key functions of TMG Bill include:
- Matching LIS levels to all applicable members
- Billing of late enrollment penalties
- Production and fulfillment of individual invoices
- Receipt of premium payments from members, SSA, RRB at Client’s designated bank account/lock box
- Prepare, send and receive ACH feeds to/from bank
- Support credit card payments through third party financial system interface
- Post and reconcile all components (CMS, LIS, Member, ACH, SSA, SPAP) premium payments
- Manage delinquency process
• Sending member failure to pay premium notice
• Process failure to pay premium disenrollment per plan procedure
- Premium Refund check processing
TMG Health’s Billing System is configured to handle both individual and group member premium billing processes. It automates both withdrawals from member accounts and credit card payments. Individual enrollee premium billing and group billing processes are all handled in compliance with CMS and our Client’s policies and timeframes.
Prior to beginning ACH withdrawal for monthly premium for a new enrollee, TMG Health can also support coordination and pre-note file with the Client’s bank to verify the correct routing numbers and account number. TMG Health reconciles ACH and direct pay members to the total membership. TMG Health can also manage the delinquency process in accordance with CMS regulations and process disenrollments for nonpayment of premium in accordance with our Client’s policies. TMG Health’s Premium Billing and delinquency processing services are compliant with CMS standards as well as with all Medicare/state regulations and Client’s requirements. Comprehensive and detailed financial and management reporting is provided. Clients also have the ability to review billing data prior to billing extract generation.
TMG HEALTH PREMIUM BILLING PROCESSING
The premium billing functionalities outlined above are supported by a comprehensive process of systems, routines and skilled staff. TMG Bill is the amalgam of these efforts and represents yet another measure of TMG Health’s ability and skill in serving the Parts C and D market segment. In short, the system enables continuous interactive monitoring of all data inputs available to TMG in order to assure the most up-to-the-minute accuracy prior to billing extract generation. This assures the highest levels of member satisfaction regarding billing and minimizes customer service inquiries and retroactive adjustments.
