Solutions-Title-BG

Medicaid Solutions

TMG Health's customized solutions are poised to skillfully handle the complexity of Medicaid plan administration in today's unprecedented regulatory and economic environment. Our technology–enabled solutions provide you with the freedom to focus on what you do best — care for your members!

50

states with client members

4.1M

members served annually

11M

claims processed annually

3M

member & provider calls per year

Compete to Win with TMG Health’s Medicaid Solutions

As Health Care Reform progresses, health plans in the government market need to prepare for the unprecedented growth in both the Medicaid and Dual Eligible populations. To be successful, plans in the Medicaid and Medicare markets need to find scalable and flexible solutions to keep pace with state and federal regulatory requirements and to stay ahead of the competition!

TMG Health’s dedicated Medicaid Services implementation and development team understands the prevailing issues in the Medicaid market and has the knowledge of and ability to implement proven solutions.

TMG Health’s proven, strategic solutions for managed care plans enable you to:

  • Manage Growth
  • Control Operation Costs
  • Meet Strict Compliance Requirements
  • Skillfully Manage Enrollment, Claims and Customer Service Processes
  • Respond Quickly to the Evolving Managed Care Market

For more information about TMG Health’s expert solutions, contact us.

Medicaid and MMP Specific Functionalities & Processes:
  • Enrollment/Eligibility
  • Claims Processing
  • Encounters Reporting
  • Medical Management
  • State Capitation/Reconciliation
  • Member & Provider Call Center
  • Data Management & Reporting
State Agency File Management
  • Third Party Resource File
  • Waiver Obligation File
  • Health Status File
Products Supported:
  • MLTSS/MLTC
  • FIDA & MMAI
  • SNP
  • TANF/CHIP
  • FHP

Experience Matters!

It takes time, resources, and complex business rules and workflows to skillfully manage the intricacies of serving the diverse populations covered by Medicaid.

With more than 18 years of experience working exclusively with government health plans, we have the experience and a broad understanding of the evolving managed care market needed for successful administration of Medicare Advantage; Medicare Part D and Managed Medicaid Plans.

TMG Health serves health plans, both large national plans and small regional plans, totaling upwards of 4 million members. Our experience culminates in a broad understanding of the challenging government market and the success markers associated with thriving within that market, including:

  • CMS Interfaces
  • Eligibility Requirements
  • Member Communication
  • Creditable Coverage and LEP
  • Coordination of Benefits
  • Grievances
  • Reporting
  • Reconciliation
  • Compliance

Medicaid Solutions

TMG Health’s customized Medicaid Solutions are poised to skillfully handle the complexity of Medicaid plan administration in today’s…

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Solutions Overview

TMG Health is the leading national provider of Business Process Outsourcing services for Medicare Advantage, Medicare Part D and…

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Capabilities Portfolio

Information Technology Business Intelligence • Compliance • Membership Processing • Claims Administration • Member & Provider Services…

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Contact our Sales Department

Teig Boyle
Vice President of Sales & Marketing

 (610) 878-9111 ext. 21223
 tboyle@tmghealth.com