Tribal Healthcare

FS Advisors TPA understands the importance of tribes providing healthcare benefits to their tribal members. Our team assists tribes with a customized benefit plan design that maximizes the use of IHS, tribal clinics, CHEF funds and other tribal resources. FS Advisors TPA’s state-of-the-art claims processing system processes claims for self-funded tribal member and employee plans.

The following features are available to help tribes maximize the value of their benefit plan design:

Medicare-Like Rate Pricing

  • Develop a custom hospital network for MLR pricing ensuring clients the best possible pricing.
  • Establish discounts for non-MLR services.
  • Distinguish tribal member employees from self-funded employee plans to provide MLR pricing
  • Process claims for MLR pricing at the time of initial payment to:
    • Maximize cash flow
    • Eliminate recovery of the claims the tribe has overpaid
    • Reduce duplication of admin and recovery fees
  • Post adjudication re-pricing

Reporting

  • Provide a data warehouse and analytical tool that integrates claims information from all claims processing systems such as the tribal clinic, the self-funded member plan, and the employee plan.
    • This tool provides tribes with a comprehensive overview of claims, services provided, and overall health risk of the Tribe.

Stop-Loss

  • Provide all the necessary documentation tribes may need to file for CHEF reimbursement.
    • Provide additional stop-loss coverage when appropriate.

Case Management

  • Case management that coordinates all tribal resources to ensure the best managed care for the member and the tribe.
  • Provide wellness and disease management services.