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Our Experience
TMG Health's National Operations and Data Center has been serving more than 1 million Medicare and Medicaid members and processing 10 million health claims annually (40,000 claims per day) for major health plans, fiscal intermediaries, insurers and providers throughout the United States for more than 30 years.

TMG Health has experience in all aspects of the Medicare and Medicaid plan outsourcing, from strategic evaluation of local markets and plan development, to managing the complex operational and system requirements of these unique and highly regulated health plans. TMG Health also partners with employers to coordinate retiree Medicare plan benefits.

Here are Some examples of our recent client experience:

Nationwide Medicare Private Fee for Service Program – Full outsourcing services provided to implement Medicare Private Fee For Service program in 10 states for one of the nation’s largest publicly traded Blue Cross Blue Shield organizations. TMG Health now provides BPO and customer services after implementing the initial program in 3 months.
Fast Track Implementation of County Medicaid Program – 50,000+ Medicaid and LTC lives converted to new managed care system with claims and administrative services.
Medicare Advantage HMO Start up for Major Medicaid Organization – One of the largest Medicaid and commercial insurance organizations in its market, with over 400,000 members, utilized TMG Health’s expertise to start up a Medicare Advantage HMO product. TMG Health provides full outsourcing services and management reporting.
Multi-State Medicare Private Fee for Service Program – Implementation and administration of new product introduction by publicly traded Medigap insurer across multi-state markets.
Multi-State Medicare PPO and Medicare Supplemental Insurance Program – A national, publicly traded managed care organization needed a cost-effective solution for bringing new products to market quickly while retaining the flexibility to enter/exit new markets with minimal capital investment at risk.
Medicaid Health Plan in Michigan – Converted 26,000 members to new managed care system and now providing claims administrative services outsourcing.
CMS PACE Medicare Demonstration Program – Full outsourcing services and reporting for CMS Medicare Demonstration Program serving Frail Elderly on behalf of 3 Midwest health plans.
Medicare Private Fee for Service Program for Individual & Group Retirees – Large Blue Cross Blue Shield organization in the Midwest has engaged TMG Health to implement Medicare Private Fee for Service plan for individual and group plan retirees.
Provider Sponsored Medicare HMO Plan – A provider-sponsored healthcare organization in the West has partnered with TMG Health to offer Medicare HMO in its service area. Full system conversion for 17,000 members and outsourcing of claims processing and administrative services.
Medicare Advantage PPO Start up for Major Medicaid Health Plan – TMG Health is providing Medicare Advantage PPO Start up services including full outsourcing of administrative and claims processing services for major Mid-Atlantic insurer.
Start Up Medicare Advantage PPO – Large Provider-Sponsored PPO with Medicaid and commercial insurance in Northeast Wisconsin utilizes TMG Health to implement Medicare Advantage product with full range of outsourcing services.
Medicare Advantage Disease Management Demonstration – TMG Health has been at the forefront of the CMS demonstration programs and most recently was engaged to implement a MA disease management demonstration for severely chronically ill beneficiaries.
Western Blue Cross Medicare HMO – TMG Health has provided full outsourcing services and system conversion for statewide Medicare HMO
Encounter Data Processing Services – TMG Health provides these services to a Pennsylvania Medicaid HMO with over 250,000 members.
Medicare Fiscal Intermediary – Extensive Medicare claims experience on behalf of one of the nation’s largest Medicare Fiscal Intermediaries with 1.8 million Medicare members.
Paper to EDI Claims Capture and Processing – A Major Blue Cross organization with more than 230,000 members manages their high volume utilizing TMG Health’s proprietary ProFix™, Claims Editor System.
Claims Processing for Major Pennsylvania Insurer – Utilized TMG Health to integrate key-from-image entry, processing and EDI claim suspense resolution for over 180,000 members.
Medicare HMO Start Up for Large NY Medicaid Plan – New product implementation and full outsourcing services for major Medicaid organization with 100,000+ lives.
Major Blue Cross Medicare Plan – Providing Medicare HMO outsourcing services for major Blue Cross insurer in New York with 50,000+ Medicare lives.