Coordinated program support requires accuracy and informed oversight
Federally recognized Native American Tribes can utilize federal programs and implement processes that increase savings. Programs such as Federal Supply Schedule (FSS) and 340B assist in managing pharmacy cost, while Sponsorship and Catastrophic Health Emergency Fund (CHEF) play an important role addressing costs within Purchased/Referred Care (PRC). Each program has distinct eligibility requirements, documentation standards, and arrangements within each Tribe’s Federal agreements with Indian Health Services (IHS).
Medicare-Like Rates (MLR), Coordination of Benefits (COB), and Payor of Last Resort (POLR) are critical in controlling costs and ensuring proper payment order within tribal benefit programs. When applied correctly, these frameworks support appropriate pricing, billing accuracy, and coordination across payers.
Careful alignment is required to ensure claims are processed in the correct order and at appropriate rates without disrupting provider relationships or member access. Effective plan design supports these programs to increase savings opportunities and optimize Tribal Sovereignty.
Included Services
- Guidance and Software for Purchased/Referred Care (PRC) processes supporting MLR and POLR
- Assistance with FSS and 340B pharmacy program coordination
- Coordination of Sponsorship and CHEF with claim tracking and documentation
- Review of billing order and payer responsibility
- Alignment considerations within Tribal Insurance programs
01
Savings & Program Review
Existing program workflows, billing practices, and documentation processes are reviewed to confirm alignment with eligibility requirements and identify areas for optimization.
02
Coordination Strategy & Ongoing Support
Recommendations are developed with the plan administrator to improve coordination between all utilized programs. Focusing on pricing accuracy with continued support as processes are refined and maintained.
Common Questions
Advisory support and customized software to coordinate services with PRC. Programs are often coordinated to ensure both correct pricing and proper payer sequencing.
Each program has distinct eligibility rules, documentation requirements, and billing structures. Without coordination, savings opportunities may be missed, and claims may be processed incorrectly.
Yes. With proper planning and communication, savings programs can be implemented in a way that maintains provider relationships and preserves member access to care.
Benefit plan design plays a critical role in enabling MLR, POLR, and other savings programs to function effectively without conflicting with coverage or access.
By optimizing federally authorized savings programs within Tribal agreements, Tribes maintain control over benefit structures while strengthening financial sustainability.