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Success Stories - Health Claims Processing in the US    There is no single method for processing health claims. In fact...      more...

Success Stories

TMF grows with each project or initiative it undertakes. We offer the following case studies to overview our efforts on some of our recently completed projects.

Setting Direction (pdf)

TMF was engaged by a major health insurance company to provide strategic planning for a legacy system modernization. The client’s major legacy systems were outdated and inflexible and did not support its strategic growth priorities. Some were installed several decades ago and were becoming increasingly more expensive and difficult to maintain. The client was looking for a replacement for these core systems and recognized the need for detailed planning and analysis for such a critical and expensive undertaking.

Gaining Control of EDI Resources (pdf)

TMF was engaged by a major health insurance company to provide strategic analysis of its EDI resource utilization. The client’s EDI transactions were administered by an EDI team within its IT department. Business units perceived the EDI team as lacking efficiency and capability needed to maintain current levels of production, let alone support growth.

Defining EDI Business Practices (pdf)

TMF was engaged by a major health insurance company to provide strategic analysis of its EDI business practices. In a previous engagement, TMF performed an analysis of the client’s technical infrastructure in regard to its processing of EDI transactions. To complete the entire scenario, TMF was requested to perform an assessment of the business practices around EDI processing.

Crossing Industries (pdf)

TMF was engaged to evaluate the policy, billing, and claims system being used by a pet insurer and to compare its features with those of current human-oriented healthcare processing systems. The goal was to discover how and if the client’s system could be enhanced to take advantage of the functional architecture found in modern systems. With the analysis provided by TMF, the client was on its way to bringing the best practices of human health insurance processing to the pet insurance industry.

Remote Support (pdf)

TMF was engaged by a major health insurance company to provide remote application systems support. The client had a long standing relationship with large provider of information technology services. The services partner owned the code that ran the client’s business and was ultimately responsible for the systems being used by the client. With TMF's guidance and support, the client was able to gain greater transparency with its services provider and enhance its control over its data.