Medicare Advantage | Medicare Part D | Managed Medicaid

Leading Provider of Business Process
Outsourcing Solutions to the
Government Health Plan Market

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Who We Are

TMG Health is the leading national provider of Business Process Outsource solutions for Medicare Advantage, Part D and Managed Medicaid plans. With more than 19 years of experience of providing technology-enabled services to the government market exclusively, our knowledge of health plan processes, State & Federal regulatory requirements and the daily challenges plans face within the government market is second to none.

Our Expert Solutions

TMG Health is the leading national provider of Business Process Outsource solutions for government sponsored health plans. Our best-in-class technology and subject matter expertise deliver superior results for any or all of your critical services for:

  • Medicare Advantage
  • Managed Medicaid
  • Medicare Part D

Your Trusted Partner

We have successfully navigated the changes for both large and small plans for more than 19 years. Our proven solutions support:

  • Growth in Medicare, Medicaid, Dual Eligibles & Medicare Part D
  • Stringent MLR Requirements
  • Strict Compliance Requirements
  • Information Management & Reporting
  • Medical Management

Industry News… View All

  • News Scroll

    August 1, 2017 - Rev Cycle Intelligence
    Accountable Care Organizations have become a staple of value-based care, but the organizations now face different challenges, such as cultural change and contract management:
    August 1, 2017 - Deloitte
    Healthcare is moving at the speed of light, and for many health systems CEOs that requires a need for agility to tackle what's now and what's next. We recently surveyed 20 CEOs from large health systems across the country to uncover what's top of mind and how they are moving forward in an uncertain - and sometimes challenging - market:
    August 1, 2017 - AHIP
    Immunization among all populations in the U.S. is one of the most cost-effective means of preventing disease. Across the country, approximately 42,000 adults and 300 children die each year from vaccine-preventable disease.
    July 19, 2017 - Kaiser Health News:
    James Cosgrove, who directs the health care reviews for the Government Accountability Office, told the House Ways & Means Subcommittee that the Medicare Advantage improper payment rate was 10% in 2016, which comes to $16.2 Billion:
    July 14, 2017 - Becker's Hospital Review:
    CMS issued its update to the 2018 Medicare Physician Fee Schedule on Thursday, which includes a proposal to cut Medicare payments by half for services provided by certain provider-owned, off-campus hospital departments:
    July 23, 2017 - Revenue Cycle Advisor:
    CMS proposed a handful of changes to the inpatient-only list in the 2018 OPPS proposed rule, including the removal of Total Knee Replacement procedures from the list.
    June 21, 2017 - Euro News/ Reuters:
    Cigna Corp CEO David Cordani told investors that the company has $7 Billion to $14 Billion in capital it could use in 2017 for mergers and acquisitions in several areas, including Medicare Advantage for older people.
    June 12, 2017 - Politico
    As one participant said, "There really has been an explosion of work in Medicaid". States are testing "Medical Homes", Accountable Care Organizations, New Quality Initiatives and a host of waivers aimed at delivering care more efficiently to high need populations:
    June 8, 2017 - American Pharmacists Association
    The Advanced Opioid Management solution aims to address the opioid addiction epidemic "by working comprehensively with Patients, Prescribers & Pharmacies to minimize early exposure while helping prevent progression to overuse and abuse". The company said.
    Combination of TMG Health Capabilities and TriZetto Software Will Enable Cognizant to Offer Enhanced Business Process Platforms and Services for Government and Public Health Programs
    June 1, 2017 - BCBS Of Texas:
    BCBS of Texas announced today it has acquired certain Medicare Advantage and Commercial Group Membership from Allegian Health Plans, a wholly-owned subsidiary of Tenet Healthcare.
    All regulatory requirements have been satisfied for BCBSTX and Allegian to complete this transaction. This transaction includes nearly 20,000 members enrolled through small, medium and large employer groups, as well as Medicare Advantage Plans.
    May 30, 2017 - Health Data Management:
    By the time a heart failure patient arrives at a hospital's emergency department in distress, it's too late to reverse progression of the often-fatal condition.
    Early detection is essential, but doctors have few existing tools. "It's a very insidious disease", said Walter Stewart, VP & Chief Research Officer for Sutter Health in Sacramento, Calif. "It overlaps with other health problems". Some 50% of heart failure patients die within 5 years.
TMG Health, Inc.
100 Four Falls Corporate Center – Suite 406
Conshohocken, PA 19428
 1-800-331-4314