Although we have clients in many different industries, we have created a special niche working with Tribal Governments and Casinos. We have spent the last fifteen years developing programs specifically for the Employees of Tribes as well as for Tribal Members.
Our clients deserve a competent Broker Partner to provide comprehensive benefit plans. Over the years we have carefully evaluated TPA's and other vendors to find the most reliable and experienced companies to assist our clients. We have seen many companies make promises to Tribes they just could not keep. We want only the best companies for our clients.
Benefits West has expert knowledge of the programs available to Tribes through their Self Funded program and we work closely with your Clinic to ease administrative duties. We continue to monitor the market to ensure the best programs specific to the Tribe's needs are in place.
Special Cost Containment Programs just for Tribes and their Enterprises:
Medicare Like Rate Repricing (MLR) Section 506 of the MMA requires hospitals to accept Medicare Like Rates as full payment for Contract Health Services eligible claims. Further, it allows the Tribe to take advantage of the Medicare Like Rates on eligible claims paid for dual covered employees- i.e. employees who are also Tribal Members living inside the Contract Health Service Delivery Area (CHSDA). MLR Recovery Even if you have not started using MLR yet, our TPA partner may be able to recover significant over payments your current TPA has already made.
Catastrophic Health Emergency Funds (CHEF); Tribal Health Plans have the ability to receive reimbursement through the CHEF program. This requires special tracking by the TPA of specific diagnoses. We work closely with the TPA to compile the documents and forward to your Clinic for signature and filing.
340B Pharmacy Pricing; Discounted pricing is available on the Employee Benefit Program if the Tribe has their own pharmacy and your pharmacy benefit manager is able to track the eligibility and access 340B pricing. This allows for substantial discounting.
Tribal Member Programs; These same programs can be used to set up a Self-Funded Tribal Member plan. We have several levels of service for our clients too choose from. MLR Claim repricing is a very simple first step. Our vendors charge a small per claim fee. NOT a percent of savings which we consider an excessive fee for this service.