A partnership with TMG Health allows health plans and PBM's to focus internal resources on member outcomes and other crucial success factors in today's competitive Medicare market
CMS submission file success rate
members served annually
claims processed annually
member & provider calls per year
As the premier provider of solutions for health plans and Pharmacy Benefit Managers (PBMs) 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:
Our empirical experience, best-in-class technology and subject matter expertise enable us to deliver superior results for your critical services, including:
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. At TMG Health, our solutions are “wrapped in compliance.” Our independent Compliance and Audit Services Department utilizes insight gained from supporting CMS health plan audits and state readiness reviews for multiple health plans in multiple states to support your team.
Our Compliance experts provide oversight and monitoring in our operational areas, internal systems configuration, processes and documentation. We also employ an Internal Audit staff and are fully compliant with SSAE 16 standards.
Our expert Medicare solutions include a host of compliance services, including:
TMG Health is a member of the National Health Care Anti-Fraud Association (NHCAA)