Managed Care Information System
MANAGED CARE INFORMATION SYSTEM AND PROPRIETARY APPLICATIONS
To succeed in today's highly competitive health care environment, organizations need the right technology to provide effective health care solutions. TMG Health utilizes the TriZetto Facets® managed care information system selected specifically for its powerful and flexible claims processing functionality. The system’s highly advanced, state-of-the-art plan/server technology delivers performance, flexibility, speed, and robust scalability. Facets® is integrated with a number of TMG Health’s proprietary software applications specifically designed to meet all CMS and state regulations as well as all contracted functional requirements. In addition to being compliant, TMG Health proprietary systems are specifically designed to address Medicare Advantage product operations and optimize performance.
- TMG Enroll – Medicare Enrollment processing application
- TMG Resolve – CMS TRR transaction automation and workflow
- TMG Recon – CMS MMR transaction automation and workflow
- TMG Bill – Comprehensive premium and subsidy information process
- TMG Call – Integrated Call Services application
- TMG KEyS – Customer Service survey data capture
- TMG Knows – CSR Knowledge Database
- PROFix – Claims Preprocessing Edits to ensure high first pass claim rates
- PROClaim – Claims workflow management and image distribution system
- TMG WKI – Web capture interface for claims, enrollment, surveys, etc.
- OCR – Tailored imaging/data capture software
TMG Health provides access to our managed care system and proprietary modules in order to assist our clients in monitoring operations delegated to TMG Health. Our clients have a fully transparent view of everything TMG is doing to administer their products. Additionally, managed care information systems modules for non-delegated functions performed by the client plan, such as Care Management and Appeals & Grievance, can be remotely accessed by our client’s staff. These modules have full integration with TMG processed data (e.g. claims or call information) allowing a client’s staff member to have a comprehensive view of member data.
TMG Health is responsible to fully configure Facets and our proprietary applications to meet CMS and state requirements. We maintain them in accordance with changing Client policies and procedures, benefit structure and provider contracts and CMS and state regulations.
