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In 2003, Congress approved the Medicare Modernization Act (MMA) permitting Tribes to obtain Medicare Like Rates (MLRs) for Tribal Members. However, few Tribes currently take advantage of this law due to lack of understanding, specialized administration and a lack of service providers willing to work with IHS and 638 facilities 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 access to participate in Medicare Like Rate repricing.
TribalCARE, powered by HealthSmart, is a milestone for Tribes seeking to reduce healthcare costs while improving quality of life for Native Americans. Only HealthSmart’s TribalCARE brings all the pieces and blends them into the product best suited — and ready today — for Tribal communities.
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Extensive MLR Repricing
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History of Complex Claim Coordination
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Coordination with Tribal Facilities
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Understanding of IHS Processes and Regulations
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