Fulfillment
Medicaid enrollment tends to be highly dynamic, as members move in and out of the plans due to changes in their eligibility, income thresholds, addresses, plan desirability, etc. As a subset of the entire enrollment and disenrollment process, fulfillment activities create the new member's first impression of the professionalism and capability of the Health Plan. Additionally, timely fulfillment ensures that the Health Plan remains compliant with timelines for processing.
In spite of the dynamic nature of Medicaid enrollment, timely and accurate management of your print and fulfillment activities remains critical to member satisfaction and revenue management. These services include delivering Welcome Kits and ID cards, remits, EOBs, EOCs, and statements.
TMG Health understands the compliance criticality, the impact on the member's perception of the Health Plan’s capability, and the overall importance of fulfillment to Medicaid Managed Care Organizations' revenue management. We offer multiple print/fulfillment services options, including an in-house printer, a national network of printers, or the ability to interface to an MCO's internal or outsourced print vendor. As part of our government health program specialization, we have also developed a proprietary application called Fulfillment Data Interface® (FDI) to oversee, track, manage and help to automate much of the printing and fulfillment process.
TMG Health provides the specialized Information Systems and automation required by state and federal contracts to enable eligibility verification; accurate enrollment and updates into the correct benefit package; claim administration; third party liability tracking, fraud and abuse investigation and reporting; and encounter reporting, including Risk Adjusted Rating analysis. We are HIPAA transaction and coding compliant. In addition, we offer support for pay-for-performance and demonstration initiatives in Medical Management, Quality Management and HEDIS reporting. Our state-of-the-art e-business systems allow your plan personnel to seamlessly continue local member customer service handling. We structure each solution to retain key client resources in support of Member and Provider Services (e.g., through the TMG Call Center) and Medical Management.
Printing Partners
Our print and fulfillment services deliver redundant, top-tier capabilities; broad, scalable capacity; and state-of-the-art technology. We have contracted with a regional printing partner that is co-located in our National Operations Center in Dunmore, Pa., to service TMG Health clients. We also offer the use of a national printing partner that serves numerous marquee health plans. Both print vendors deliver quality and time-sensitive services, specialize in health insurance print and mail fulfillment utilizing HIPAA and CMS/state agency compliant operations, and are SAS Level II rated.
Highlights of these partner vendors and capability include:
- Quality, HIPAA-focused organizations specializing in health insurance print and mail
- High Volume Mailing Performed Routinely
- Compliance Training and Standards
- Local Vendor co-located to service TMG Health on-site (SAS 70 compliant)
- National Partner serving numerous national plans (SAS 70 compliant)
- Health Insurance and Finance Industry specialists High volume Heidelberg, Xerox, Xeikon, IBM, Diddle, Presses/Equipment
Because of the demands of HIPAA, OIG security, our vendors have established comprehensive compliance screening, training and testing procedures, so you can rest assured that your data is being handled responsibly, with appropriate safeguards in place.
Fulfillment Data Interface®
TMG’s proprietary FDI system automates the print fulfillment process while assuring quality and on-time delivery of all Medicaid print data within specified timelines. Key features include:
- Central repository for data feeds from production units and print vendors
- Template setup and letter merging controlled within FDI environment
- Provides automated validation of data files & manual quality review
- Real time error corrections and re-triggers
- Segregates and flags critical records for expedited processing
- Stores image of mailed document with date mailed
- Reprint functionality for audits
- Produces tracking reports for direct process oversight and tracking
As mentioned above, TMG Health can also interface to your Health Plan’s existing internal or third-party print and fulfillment vendor. In that case, we will still utilize all of the capabilities of our FDI application to ensure we correctly track and report on production completion, accuracy and timeliness.
Adhering to the tight timelines dictated by CMS and state agencies for government health programs is challenging, especially for Health Plans offering both commercial and government-based insurance products. TMG Health can ensure that the print and fulfillment needs of your Medicaid products are produced consistently, compliantly and on time. The results are a better member experience and improved revenue management.
