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What We Do2017-07-18T00:23:09+00:00

Comprehensive TPA Services

HWMG is your comprehensive health and benefit plan management solution. We offer a wide range of client support, administrative services, provider access and network leasing that can be customized to meet your health plan needs.

If you are unfamiliar with self-funding, our team is available to explain its benefits. Here is one of many resources available for employers and plan sponsors interested in learning more: Self-Funding Information & Real-Life Success Stories.

Services

HWMG provides personalized service and assistance in day-to-day health plan administration. We will work with you to customize the design of your medical, dental, vision and prescription drug plan offerings.
We provide members with quality healthcare access to thousands of participating providers by:

  • Establishing network performance and coverage goals consistent with accreditation and industry standards, and monitoring measurements so improvements can be made where necessary.
  • Owning and operating our PPO network of medical and dental providers within the State of Hawaii.
  • Contracting with other provider networks for access to certain services and pharmacies throughout Hawaii and the U.S. Mainland.

View our provider network listing.

HWMG leases our PPO networks to clients interested in establishing a presence in Hawaii or accessing certain services on the U.S. Mainland.
We understand the medical needs of our members, especially in Hawaii, and offer telehealth services to providers, clients and members through our partner, HiDoc.
Our Taft-Hartley Division has more than 25 years of experience in the Taft-Hartley and unionized health plan industry. It is dedicated to providing client support and reliable services to unionized clients by:

  • Assisting with the administration of their members’ Health & Welfare Trusts
  • Offering specialized solutions to help labor unions manage their employee benefits
  • Conducting informational workshops and open enrollment meetings
Our Claims team ensures prompt and accurate payment of electronic and paper claims in accordance with government regulations, health plan documents, client expectations, and company benchmarks. We emphasize timeliness and quality performance by:

  • Comparing claims processing performance measures to established goals and standards
  • Conducting system edits during the claims adjudication process
  • Performing claim audits, both pre- and post-payment
Our Customer Service Center is dedicated to providing superior service to our clients, members, and providers regarding benefits and claims. We emphasize responsiveness, ensure customer satisfaction, and recognize cultural diversity by:

  • Comparing call center performance measures to established goals and standards
  • Reporting concerns to our Quality Management Committee to identify improvements that can be made to mitigate similar concerns in the future
  • Providing foreign language translation services
Our Health Management team is comprised of local Registered Nurses, all of whom are Certified Case Managers conducting precertification and utilization review in our office with oversight by HWMG’s Chief Medical Officer. We ensure members receive appropriate levels of care as well as aim to prevent unnecessary or inappropriate utilization of insurance benefits by:

  • Working closely with healthcare providers
  • Performing utilization and case management using standard industry criteria with clinical oversight in various specialties
  • Engaging clinical review with qualified providers for consulting services
We provide services and resources needed to start or enhance a company’s Worksite Wellness Program. We make it easy for companies to use our customizable program to suit their needs, by offering the following services:

  • Clinical analysis and utilization reports
  • Worksite wellness planning
  • Member engagement events such as onsite biometric screenings, health fairs, and educational workshops
  • Maternity and baby care incentive program
  • Flu vaccinations onsite or at selected pharmacies during flu season
  • Special discounts on fitness memberships, food & beverages, spa services, and other wellness products and services
We give our clients the flexibility and convenience of accessing their account information 24 hours a day, 7 days a week. Certain requirements apply.

  • Members can view their plan benefits, eligibility, and claims.
  • Health plan administrators can manage member eligibility, view billing statements, and access other administrative tools.
  • Participating Providers can verify patient eligibility, view claims status and payment information, and access other provider services.
We provide our clients with periodic updates on relevant legislation that could affect their health plan. HWMG will also coordinate the preparation and mailing of compliance communication to members upon request. Our experienced Compliance team will help with general questions on compliance issues, state and federal reports and forms, and specific compliance projects upon request.
Our team has comprehensive experience with health plan reinsurance and provides services that include, but are not limited to:

  • Assistance in reinsurance contracting
  • Reinsurance administration and audits
  • Reinsurance claim notification and management
Our comprehensive COBRA and HIPAA administration helps ensure your company is in compliance with the latest regulations. Services include, but are not limited to:

  • Notifying employees of coverage termination
  • Processing of COBRA enrollments and automated tracking of election periods
  • Maintaining and reconciling individual accounts including premium collection and past-due notices
  • Answering inquiries from members who continue their plan coverage under COBRA or USERRA provisions
  • Preparing reports for Plan Sponsors on COBRA and USERRA cases
We customize plan documents, membership cards, and reports to ensure they are easy to understand and meet our clients’ needs. With our custom reporting package options, clients can choose the frequency and format of their reports, such as Microsoft Word, Excel, pdf, or printed copy. Reports include, but are not limited to:

  • Key Performance Standards
  • Claim Disbursements
  • Eligibility (including COBRA)
  • Medical and Prescription Plan Utilization