TNGA is a provider network company focused on contracting with independent therapy providers (PT/OT/ST) in order to arrange for outpatient rehabilitative services on behalf of health plans and their assigned members. TNGA and its affiliated companies provide rehabilitation services to over 1.2 million health plan members through its 1,100+ contracted provider locations. TNGA and its affiliated companies operate in four different U.S. markets and cover all lines of business (Medicaid, SCHIP, Medicare, Commercial HMO, Commercial PPO).
TNGA is a privately owned organization. Its owners are also the founders and operators of the company. For more than seven years, TNGA and its affiliated companies have contracted with nine different health plans to provide therapy network management services.
TNGA is contracted with WellCare of Georgia to coordinate the provision of outpatient therapy (PT/OT/ST) services to WellCare members through a network of therapy providers contracted with TNGA. The company has been in partnership with WellCare Health Plans, Inc. for over six years, providing medical management for Wellcare of Florida lines of business.
TNGA maintains regular business hours of 8 a.m. to 5 p.m. Monday–Friday. After regular business hours, a TNGA representative is available for urgent cases that need immediate attention by calling 1-855-825-7818, Option #1.
The holidays that TNGA observes are: New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, the day after Thanksgiving and Christmas Day.
TNGA will be administering therapy benefits for all WellCare of Georgia's Medicaid, PeachCare for Kids®, and Medicare members. TNGA's claims payment turnaround standards are as follows: Medicare — 95% of clean electronic claims are paid within 15 calendar days from the date of receipt and 95% of clean paper claims are paid within 30 calendar days of receipt. Medicaid: 95% of clean electronic claims are processed in 15 business days and 95% of clean paper claims are paid within 30 calendar days of receipt. For additional information, please visit www.mytnga.com.
Yes, TNGA will be processing provider claims for the therapy services under its agreement with WellCare of Georgia.
A number of factors were taken into consideration as part of the methodology for determining the case rate level and pricing for each therapy case. These factors include:
Members Enrolled in Babies Can't Wait
Each authorized case rate is valid for a certain defined period based on clinical review of the case.
TNGA will only issue authorizations for upgrades when a change in diagnosis or a change in test scores is submitted. (In rare clinical circumstances, upgrades may be authorized without a change in either diagnosis or test scores).
The Upgrade Request must include the following:
UPGRADES WILL NOT BE AUTHORIZED RETROSPECTIVELY (AFTER THE TREATMENT PERIOD)
No, there is not a financial recoupment of the case rate under these circumstances.
A separate case rate is paid for each medically necessary therapy discipline (PT, OT, ST). The network reimburses for therapy services in the same manner whether it is performed on an individual member basis or through group therapy sessions.
All Medicare providers may submit authorization requests via fax to 855-597-2697. Medicare providers are also able to submit authorization request to TNGA through TNGA's provider web portal (PWP). Providers may access the PWP at www.mytnga.com and selecting "Login" on the Home page. For technical questions concerning the PWP, providers may submit them to our web portal team once they are logged in to the PWP. There are also self-service options on the PWP login page. To request a PWP account, please select "Request PWP Account" from the Home page at mytnga.com
All Medicaid providers must use the State of Georgia (DCH's) secure provider portal (GAMMIS) as the single point of entry for submission of prior authorization requests for Georgia Medicaid members. Providers will also be able to verify receipt of auths via this portal. All providers may also verify the status of their authorization requests on the TNGA PWP regardless of the mean of submission.
Submitting patient information by regular email is not permitted due to HIPAA (PHI.)
Clinical support can be requested by contacting TNGA at 855-825-7818 and a clinician, in turn, will contact the provider and schedule a time/date to speak that is convenient for both individuals.
The case rate is processed upon receipt of the first claim associated with the case. Clean claims are paid on a weekly basis and most are paid within 15 business days when electronically submitted, 30 days for paper claims. Providers should continue to submit subsequent claims for services rendered in relationship to the case period, although no additional payment will be disbursed. Reimbursement to providers for therapy services rendered to members enrolled in Babies Can't Wait will be paid fee-for-service. Clean claims are paid on a weekly basis and most are paid within 15 business days when electronically submitted, 30 days for paper claims.