Project Examples
Compliance and Regulatory Services
Health Tradition Health Plan, LaCrosse
April 1997 - Ongoing
TMG provides ongoing compliance and regulatory services, including technical assistance, preparing and completing required filings with the Wisconsin Office of the Commissioner of Insurance (OCI), developing policies and procedures to comply with Wisconsin laws and regulations for managed care organizations, monitoring insurance and managed care regulatory activities, and providing information and updates on compliance activities.
TMG completed a comprehensive rewrite/revision and creation of all insurance forms for Health Tradition's commercial and Medicare Select products. Also assisted with development of a Medicare Risk/Medicare+Choice application to the Centers for Medicare and Medicaid Services (CMS), refiled all company insurance forms with OCI when the health plan changed ownership, and assisted the health plan to complete an OCI market conduct examination.
Compliance and Regulatory Services
PHP Insurance Plan, Inc. (d/b/a Prevea Health Plan), Green Bay
March 2001 - Ongoing
TMG provides a comprehensive package of compliance and regulatory services for Prevea Health Plan (PHP). These services are designed to assist PHP to identify areas within the health plan that will be affected by changes in Wisconsin law and facilitate a process to make certain that all necessary activities are completed within a prescribed time frame. These services include insurance forms compliance and filing, policy and procedure review, and development of an ongoing plan to meet Wisconsin's compliance requirements.
TMG assisted PHP to complete a comprehensive compliance program to set standards and address compliance with federal and state regulations. A specific area of focus includes the requirements set forth in state law, which specifies certain compliance program components for managed care organizations in Wisconsin. TMG assisted PHP in preparation of the response to a comprehensive market conduct examination and related filings.
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