Fact Sheet

TMG Health, a Cognizant Company, offers technology-enabled Business Process-as-a-Service (BPaaS) solutions for insurers, employers, health plans, and providers in the Medicare Advantage, Medicare Part D and Managed Medicaid and Group Retiree health plan markets. As the largest and most experienced outsourcer in this market, we offer an innovative and comprehensive suite of services designed to minimize a plan’s capital investment, lower its ongoing operational costs and reduce the risks associated with Medicare Advantage and Medicaid Managed Care plan administration.

Our efficient implementation process reduces the time required to launch new products or expand into new service areas. Compliance with all CMS requirements is our foremost concern and customer satisfaction is our driving goal.

1998

Founding Year

1900+

Associates

32

Client Plans

4.3M

Members Served

1998
 

Founding Year

1900+
 

Employees

32
 

Client Plans

4.3M
 

Members Served

Locations

Corporate Headquarters

100 Four Falls Corporate Center
Suite 406
Conshohocken, PA 19428

 (610) 878-9111
 (610) 878-5525
Map/Directions

National Center of Excellence for Medicare/Medicaid Services

25 Lakeview Drive
Valley View Business Park
Jessup, PA 18434
 (570) 344-9237
Map/Directions

Amarillo Call Center

7901 Wallace Blvd.
Amarillo, TX 79124

 (806) 457-2650
Map/Directions
Target Markets

Plans and products within the government health programs market, including Medicare Advantage, Managed Medicaid (including Medicaid Long Term Care), Medicare – Medicaid Alignment Initiative (MMAI – Dual Eligibles), Medicare Part D and Group Retiree markets. Examples include PPO, PFFS, HMO, SNP, PDP and MSA.

Customers

TMG Health, a Cognizant Company, serves multiple health plans and insurers with members in all 50 states, including one of the nation’s largest Pharmacy Benefit Managers. Our Business Process-as-a-Service customers typically include:

  • Medicare Advantage Plans
  • Medicare Part D Plans/Pharmacy Benefit Managers
  • Managed Medicaid Plans
Workload Volumes

TMG Health, a Cognizant Company, supports more than 4.3 million members and handles over 14 million health claims, 30 million enrollment transactions and 3.5 million member and provider calls annually.

Service Portfolio/Delivery Models

TMG Health, a Cognizant Company, offers a comprehensive suite of administrative services which can be utilized as an end-to-end solution or can be integrated as individual components. Our proven solutions feature automation and accuracy and ensure compliance with federal and state regulations.
Services include:

  • Compliance Tracking and Audit Assistance
  • Fraud, Waste & Abuse Prevention and Detection
  • Enrollment, Eligibility, and Reconciliation
  • Claims Administration
  • EDPS Encounter Processing
  • Client Financial Services, including Analytics
  • Full Suite of Print & Fulfillment Services
  • CMS and State Reporting
  • Member and Provider Call Center Services
Security and Flexibility

TMG Health, a Cognizant Company, utilizes the most sophisticated and reliable technology available, including redundant Tier IV Data Centers, to ensure non-stop service and fail-safe operations. All production is backed up in a Tier IV Data Center in Waukegan, Illinois and replicated at a second Tier IV Data Center in Fort Worth, Texas. Our Fort Worth facility also houses Development, Testing, and Disaster Recovery failover.

Contact:

John Montague
Director of Sales Support
(610) 878-9111 ext. 21206
jmontague@tmghealth.com