Advertisement
TMG Health's most important internally developed application streamlinesthe processing of enrollment applications by automatically applying over 280CMS and specific plan eligibility business rules. These front-end processrules flag duplicate members, ensure county-to-r plan (PBP) matches, andverify CMS eligibility in real-time. The overall advantage is more streamlinedtimely and accurate enrollment resulting in a 98% TRR total acceptance/totalcodes rate within specific CMS guidelines.
Advertisement
TMG also developed a web based tracking and work flow software applicationnamed Resolve designed to automate and better manage CMS TRR reports. Resolveprovides details of TRR data, acceptance/rejection/maintenance codes, agingand processor performance. TMG automates a series of TRR codes which aretranslated into Resolve as completed or "worked" when the TRR is loaded. Theresult of the automation is accurate and compliant processing of the TRR.
Additionally, TMG recently enhanced its internal document controlprocedures in the development of LRP. LRP is a complete end-to-end processcreating a closed loop system for all letter mailings. This process providesenhanced quality control by tracking all correspondence requests, real-timecorrespondence processing, document imaging, and insures that proper invoicingof all associated correspondence costs are generated. It reinforces TMGHealth's SAS 70 internal control requirements.
About TMG Health
TMG Health is the leading provider of Business Process Outsourcing (BPO)services to the Medicare, Medicaid and retiree health plan markets. TMGprovides operational outsourcing solutions and systems for health plans,providers and insurers. TMG is the most experienced vendor in the market andhas the broadest solution set serving over 30 health plans in all 50 states.Benefits of partnering with TMG Health include low, fixed operational costs,reduced capital costs, uniquely designed, state-of-the-art systems, rapidimplementations and proven regulatory compliance.
TMG Health is a privately held corporation located in suburbanPhiladelphia with a National Operations Center in Northeastern Pennsylvania.For more information, please visit www.tmghealth.com.Media Contact: Judy Cohen (610) 304-5470 [email protected]
SOURCE TMG Health
