We are expert in the establishment of self-funded health plans for tribal entities, providing groups with the ability to customize plan designs, clinical based initiatives, health outreach and member communication materials. With an understanding that each tribal client is unique, we provide a customized fit for each tribe’s cultural needs, healthcare expectations and service standards and are always looking for alternate measures to ensure a plan’s long-term financial stability.
Medicare Like Rate (MLR) &
Purchased/Referred Care (PRC) Pricing
Our dynamic infrastructure provides MLR repricing for physician and hospital claims alike.
Emergency Fund (CHEF)
We access the Indian Health Services (IHS) Catastrophic Health Emergency Fund (CHEF) intended to minimize the burden of high dollar catastrophic events exceeding $20,000.
340B Rx Pricing
We help ensure that tribal clients benefit
from the valuable program which represents the lowest cost drug pricing manufacturers charge the federal government.
Our Tribal Sponsored Premium Programs use monthly predictive modeling reports to proactively move high risk and high cost tribal members to Affordable Care Act (ACA) exchanges in order to limit the tribe's financial risk while providing a safety net for the tribal member in covering their out-of-pocket responsibility.