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Presented by: Tyler Moore, Mattecheck & Associates and Face Rock Enterprises.

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Presentation on theme: "Presented by: Tyler Moore, Mattecheck & Associates and Face Rock Enterprises."— Presentation transcript:

1 Presented by: Tyler Moore, Mattecheck & Associates and Face Rock Enterprises

2  Under 25 U.S.C § 1623(b) the Tribe becomes the payer of last resort for claims incurred by a Contract Health Services (CHS) eligible member/employee  All other coverage would be primary including:  Coverage under a spouse’s health plan  Coverage under Medicare  Coverage under Medicaid

3  Positively impacts the CHS and Health Plan budget by shifting claims cost to other payers without impacting the members out-of-pocket (both the Tribal Member Plan and the Employer Sponsored Plan)  Impact varies drastically based on:  Number of CHS eligible employees  Number of Tribal Members who have other coverage

4  The Tribe’s health programs must be self- funded  The health plan documents must have the correct language included  The Tribe and/or the health plan third party administrator (TPA) must correctly manage eligibility  The Tribe’s TPA must understand how to apply and enforce the Payor of Last Resort

5  Partner with a subject matter expert to help set up and manage the Tribe’s health programs  Find the right third party administrator (TPA)  Conduct a coordination of benefit (COB) audit  Provide Tribal Member assistance – enrolling in Medicare/Medicaid

6 Questions? Tyler Moore (541)


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