Premier Provider of Medicare Solutions

As the premier provider of solutions for health plans and Pharmacy Benefit Managers (PBM’s) in the Medicare Advantage, MAPD and Medicare Part D markets, TMG Health offers end-to-end strategic sourcing and component solutions which are designed to keep pace with the changing needs of the government healthcare market.

Our Medicare solutions enable payers to:
  • Manage Growth
  • Control Costs
  • Meet Strict Compliance & MLR Requirements
  • Skillfully Manage Enrollment, Claims & Customer Service Processes
  • Skillfully Manage processes for the complex Dual Eligible population
   We provide:
  • Rapid Implementation &
    On-Boarding
  • Process Transparency
  • Data Security with Fully-Redundant Network Capabilities & 2 Tier IV Data Centers
  • Project Management

More on our Medicare Solutions/Compliance Assurance...

Our empirical experience, best-in-class technology and subject matter expertise enable us to deliver superior results for your critical services, including:

  • Enrollment, Eligibility Management and Reconciliation (CMS & Medicaid)
  • Premium Billing
  • Claims & Encounter Processing
  • Member/Provider Call Services
  • Creditable Coverage & LEP
  • CMS and State Reporting
  • Financial & Capitation Reconciliation
  • Print Fulfillment
  • Compliance Tracking & Assistance
  • Medical Management

Compliance Assurance

CMS Star Ratings determine reimbursement rates and can ultimately determine the profitability of a Medicare Advantage program. Health plans need an experienced partner who knows how to navigate the rapidly-evolving regulatory environment. TMG Health operates like a health plan, with a Compliance Committee, a Compliance Officer, and a full Compliance Department. We oversee all activities related to implementing and maintaining CMS regulatory requirements and adhering to Federal and State laws.

Our expert Medicare solutions include a host of compliance services, including:

  • HPMS & CMS Guidance Directive Monitoring
  • Audit Support
  • CMS User Group Calls
  • AEP Preparation Assistance
  • Performance Monitoring & Reporting
  • Fraud, Waste and Abuse Reporting

Contact us to learn more about our Medicare Solutions…