Presentation on theme: "Presented by: Tyler Moore, Mattecheck & Associates and Face Rock Enterprises."— Presentation transcript:
Presented by: Tyler Moore, Mattecheck & Associates and Face Rock Enterprises
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
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
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
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
Questions? Tyler Moore email@example.com (541) 504-4139
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