TribalCARE, powered by HealthSmart, is a major event for Tribes seeking to reduce healthcare costs while improving quality of life for all Native Americans. Only HealthSmart’s TribalCARE brings all the pieces and blends them into the product best suited — and ready today — for Tribal Communities.
Getting To Know TribalCARE
- TribalCARE is a trademarked new service from HealthSmart (patent pending)
- TribalCARE coordinates with Indian Health System (IHS) and 638 facilities to maximize the availability of Medicare Like Rates (MLR) for eligible Tribal Members
- TribalCARE obtains IHS authorization, notifies the provider and coordinates payment to the provider at 40% to 65% MLR savings
In 2003, Congress approved the Medicare Modernization Act (MMA) permitting Tribes to obtain MLR for Tribal Members. However, few Tribes currently take advantage of this law due to a lack of understanding, specialized administration and a lack of service providers willing to work with IHS and 638s on obtaining MLRs.
HealthSmart ignited the MLR Tribal services industry and has a rich history of providing MLR services, Tribal healthcare claim processing and managed care services. TribalCARE was developed out of our experience in working with Tribes, processing claims and providing Medicare pricing expertise.
With TribalCARE, now all Tribes, including government and enterprise entities, have the opportunity to participate in Medicare Like Rate repricing.
Any Tribe may qualify. TribalCARE is available for all Tribal and Tribal enterprise self-funded plans. Our wellness and managed care services can also be tailored to best meet your specific Tribe’s needs, budgets and community healthcare priorities.
TribalCARE, Powered by HealthSmart, Offers:
- MLR Reduced Rates on Eligible Services: Allows the Tribe to keep more of its money to use for other Tribal health-related priorities
- Coordination With Tribal Sovereignty: Including the unique laws that apply to Tribal entities and coordination with your IHS or 638 facility to maximize funding and get the most out of your dollars spent
- Enhanced Quality of Life: Access quality of life enhancing services designed to not only save Tribes more money, but also provide coaching for Tribal Members and work with them to develop healthy lifestyle changes
How It Works
TribalCARE works with the Tribe’s healthcare network, physicians and hospitals to provide reduced rates and increased access to life-enhancing services.
- Pre-Cert / IHS Authorizations: TribalCARE coordinates with IHS, the doctor and the Tribe to ensure every eligible Tribal Member gets the MLR for eligible services
- Claims Processing: TribalCARE ensures all claims are paid quickly and accurately to each provider for each MLR-eligible claim
- Reporting & Accountability: TribalCARE provides detailed monthly reports denoting claim activities and the MLR claims along with Tribal savings from month to month
- Combines A Unique & Rare Solution
- Delivers 40%+ Medicare-Like-Rate (MLR) Savings
- Processes MLR & Commercial Claims
- Offers each Tribal Group a Single Vendor / Single Contact
Editor’s Note: Reducing health care costs by paying “Medicare Like Rates” to providers? What a novel idea!