Enrollment

ENROLLMENT/DISENROLLMENT PROCESSING

Timely and accurate management of the enrollment process is critical to the life blood of a Health Plan. It drives membership rosters and, therefore, reimbursement. Equally importantly, it represents the new member’s first impression of the professionalism and capability of the Health Plan. Timely generation of new member materials and welcome kits are critical to this first positive impression. TMG Health understands both the compliance criticality of a timely enrollment as well as the benefit to the member experience. We have developed a proprietary application called TMG Enroll® to help automate much of the enrollment process and ensure both timely and accurate enrollment processing.

The scope of enrollment and disenrollment services available from TMG Health includes the following:

• Receipt of application forms from client via paper, image or via an electronic file from plan,
  employer produced data and web application submission

• Electronic imaging of paper enrollment forms

• Extensive TMG Enroll® applicant data editing to detect and correct issues and assure high accretion rates

• Pre-verification against BEQ/Medicare Beneficiary Database to enhance acceptance on
  first-submission to CMS

• Notification of ineligibles via letter

• Process cancellations and disenrollments

• Application verification calls with subsequent member data request (RFI letters) and
  revision as needed

• Transmit data to CMS and reprocess rejections to fullest extent

• Enrollment records storage archival

• ID cards and fulfillment

• Member Welcome and/or Education calls

TMG Enroll®
TMG Health’s proprietary enrollment automation and processing application incorporates over 1,000 CMS, Health Plan and TMG-specific business rules and edits for applicant data. It automates the verification of each applicant against the Common Working File before certifying the application for submission to CMS. Below is a summary of the key features and benefits of TMG Enroll:

• Accelerates the New Enrollment Process – TMG Enroll streamlines the process flow and data entry by providing a user friendly step by step process. Each Plan customer can have default field values populated for information which is always the same, eliminating key strokes and incorrect data entry processes.

• Data Validation and Correction – TMG Enroll can apply over 1,000 automated edits based on CMS, Plan and TMG requirements. No enrollment can be submitted to CMS or our managed care information system until all TMG Enroll® rules are met. Specific Rules and Edits include:
  
       • CMS Required Fields for a Completed Enrollment, Disenrollment or Plan Change
  
       • CMS eligibility and election period requirements
  
       • Rules and requirements specific to the plan type and service area

• Reduces Labor Requirements – Streamlined enrollment screens and fewer mistakes quicken the enrollment process which leads to reduced labor to complete all tasks involved in a new enrollment.

• Enhances CMS Verification Process – An electronic verification process greatly reduces the time needed to complete comparison of applicant data against the CWF.

• Batch Enrollment Import – TMG Enroll® facilitates the import of files containing new enrollment records.  These records appear in the staging area and are then sent through the CMS verification and TMG Enroll® validation processes.

TMG Health utilizes proprietary automated processes for both data capture of enrollment information and the receipt of electronic membership files from employer groups or plans providing electronic eligibility data. The enrollment and eligibility information is stored in the Subscriber/Member Application module of our managed care information system. TMG Health has configured our systems to maintain Medicare-specific information including status (e.g. working aged, institutional, ESRD, Medicaid, disabled, etc.), risk adjustment category, county, HIC number, Medicare Part A and B eligibility, and CHF indicator. TMG Health also tracks application signature date, election type, LIS data and plan benefit type ID number.

TMG Health has also developed automated processes for the submission of Medicare membership and election data to CMS, and for the receipt of the weekly transaction reply files (TRR) to automate the activation of members and correspondence triggers upon CMS acceptance.

TMG Health Enrollment/Disenrollment processing ensures applications are processed in a timely and accurate manner resulting in enhanced revenues, compliant operations and satisfied members. Through time and stress tested proprietary automation, TMG will help your Health Plan grow and maintain a competitive advantage.