Technical Assistance

• Respond to the health plan staff questions about compliance and regulatory issues. Research and obtain information as requested.

Wisconsin Compliance/Regulatory Activities

• Monitor insurance and managed care regulatory activities and provide information and updates on compliance activities, respond to inquiries, and provide timely and appropriate follow-up as needed.
• Attend necessary meetings and hearings; provide summary reports of hearings and other regulatory activities.

Insurance Form Filings with Office of the Commissioner of Insurance (OCI)

• Provide assistance to key health plan staff to determine any necessary changes to forms due to regulatory activity or changes in plan operations.
• Assist health plan staff to revise current insurance forms or develop new forms.
• Provide comprehensive assistance to the health plan for submission of all insurance form filings for their commercial and Medicare Select products, including preparation of the OCI forms and all items to be included in the submission packet to OCI.
• Act as the central contact with OCI to facilitate the submission, review, and approval of all filings.

Comprehensive Project Facilitation/Support

• Assist the health plan to assess and evaluate its status with regard to compliance with applicable federal and state statutes and requirements for managed care organizations in Wisconsin. Identify projects to assist the health plan to operationalize federal/state requirements.
• Provide comprehensive technical support for projects that may be identified, such as certificate rewrites or development of a compliance program.

Special Projects (Examples)

• Independent Review:TMG assisted managed care organizations to:

Ø      Review and revise current policies and procedures for inclusion of the independent review process.

Ø      Develop a Notice for Independent Review.

Ø      Develop policy/certificate language.

Ø      Develop model policy/procedures for independent review.

• OCI Market Conduct Exam: TMG assists managed care organizations to:

Ø      Provide preparation for the on-site OCI audit.

Ø      Provide preparation and submission of response to OCI's compliance order.

Wisconsin managed care organizations must comply with numerous requirements found in federal law and regulations, state statutes, and state administrative codes. These requirements include specific standards and timetables for disclosure, notice to policyholders and consumers, and reporting and auditing. New laws and administrative rules frequently affect virtually every product, policy and procedure. It is, and will continue to be, more complicated for managed care organizations to comply with all the present and future regulatory requirements.

TMG takes the time to learn about each organization and its staff and operations, and tailors its work products to reflect each client's needs. TMG provides the structure to make certain that all necessary activities to comply with law are completed within a prescribed time frame.