Fact Sheet
Profile
TMG Health offers technology enabled Business Process Outsourcing (BPO) services for insurers, employers, health plans, and providers in the Medicare Advantage, Part D, Medicaid Managed Care and Group Retiree health plan markets. As the largest and most experienced BPO processor in this market, TMG Health offers an innovative and comprehensive suite of services designed to minimize a plan's capital investment, lower their 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.
Founded
1998
Number of Employees
990
Number of Clients
30
Number of Members Served
2.8 million
Corporate Address
TMG Health, Inc.
455 S. Gulph Road
Suite 307
King of Prussia, PA 19406
Telephone: (610) 878-9111
Fax: (610) 878-5525
Operations Center Address
201 Lackawanna Ave.
Scranton, PA 18503
Telephone: (888) 924-3905
|
7901 Wallace Blvd.
Amarillo, TX 79124 |
1205 O'Neill Highway
Dunmore, PA 18512
Telephone: (888) 924-3905
Web Address
www.tmghealth.com
Key Management
John T. Tighe III, Founder, President and CEO
Robert Dunn, Senior Vice President and Chief Operating Officer
James H. Watson, Senior Vice President and Chief Financial Officer (interim)
John Reza, Chief Information Officer
Olga Thornton, Senior Vice President and Chief Compliance Officer
William F. Haggett, Senior Vice President for Sales and Marketing (interim)
Vincent M. Dadamo, Senior Vice President and General Counsel
Debra Kircher, Vice President of Medicaid Services
Kimberly Line Courtois, Vice President of Human Resources
Barry Walsh, Vice President of Claims
Deanna Forte-Lahey, Vice President, Customer and Ancillary Services
Marcia Laleman, Vice President of Enrollment and Billing Services
Target Markets
Medicare Advantage, Medicaid Managed Care, Part D and Group Retiree markets with focus on the array of insurance plans and products that derive from these public health programs. Examples include: PPO, PFFS, PDPHMO, SNP, PDP, Med Supp and MSA.
Customers
TMG serves over 30 separate health plans and insurers with members in all 50 states.
Customers serviced by TMG Health include:
- One of the nation's largest PBMs for Part D administration
- Fourteen Blue Cross Blue Shield plans
- The largest and fastest growing SNP in the Country
- More than 125 retiree groups for MA, MAPD and PDP products
- 14 PFFS products (successfully launched over the past 8 years)
- Provider owned Medicare Plan
Workload Volumes
TMG Health supports over 2.8 million Medicare and Medicaid members and handles over 20 million health claims, up to 1 million enrollments and 1.5 million service calls annually.
Service Portfolio/Delivery Models
TMG Health offers a comprehensive suite of services which can be utilized in a fully
integrated manner or as individual components. The available services include:
- Managed Care IS systems, data management/reporting
- Enrollment and eligibility processing
- Premium billing and reconciliation
- Claims imaging, OCR and processing
- Member and provider services and call center
- Fulfillment for claims processing and premium billing
- Health risk screening, working aged and Part D COB surveys
- Medical management system support and consulting
- Support marketing services
Security and Flexibility
TMG Health's Operations Center uses the most sophisticated and reliable technology available to ensure non-stop service and fail-safe operations. The core technology includes TriZetto's Facets Managed Care Information System, specifically configured to address the unique requirements of Medicare and Medicaid processing. TMG Health enhances this core system with a number of highly specialized proprietary and third-party applications to achieve unparalleled operational productivity.
Processing services are available in a variety of delivery options including:
- Full Business Process Outsourcing (BPO) service suite
- Flexible bundling of turnkey services
- Transaction services (e.g., claims pre-processing)
- Medicare Advantage Part D or MAPD standalone processing
Contact
John Troge
Senior Director of Marketing
610-878-9111 x 214
jtroge@tmghealth.com