Benefit
Administration
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Our comprehensive health plan administration is based on years of experience of:
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Serving Tribal organizations and enterprises and following Tribe-related regulations.
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Performing MLR claim repricing, and delivering those savings back to the Tribe
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Identifying and processing claims from both Tribal and non-Tribal employees
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Coordinating with Tribal Sovereignty, IHS, 638 Facilities and others to maximize funding
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Network Solutions
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Our wholly-owned provider networks and nationwide network partnerships offer up to a 65% discount on preferred providers. We achieve significant savings by using our own secondary network (the 2nd largest in the country) and aggressively negotiating out-of-network claims.
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Care Management
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We apply aggressive case management, disease management and wellness services. Predictive modeling tools forecast future costs and identify at-risk members. Professional RNs monitor and coach member engagement.
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Pharmacy Administration
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We reduce pharmacy expenses through transparency and a focus on generic utilization. We present end-to-end disclosure with full pass-through to reduce Rx spending by 20%. Your Tribe keeps ALL the savings.
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Risk Management
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We provide a range of sound stop-loss solutions from highly-rated carriers to help manage your Tribe’s risk and reduce financial exposure.
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Reporting & Data Analysis
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Data analysis is key to managing costs. Our single managed care platform powers our comprehensive and dynamic analytics and reporting tools.
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