Payor of Last Resort Tribal Presentation
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Transcript Payor of Last Resort Tribal Presentation
TRIBAL SELF-INSURED HEALTH PLANS
PAYOR OF LAST RESORT
Presented by:
Tyler Moore, Mattecheck & Associates and Face Rock Enterprises
PAYOR OF LAST RESORT - OVERVIEW
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
PAYOR OF LAST RESORT – FINANCIAL BENEFIT
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
PAYOR OF LAST RESORT – KEY FEATURES
The Tribe’s health programs must be selffunded
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
PAYOR OF LAST RESORT - CONSIDERATIONS
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
PAYOR OF LAST RESORT – QUESTIONS?
Questions?
Tyler Moore
[email protected]
(541) 504-4139