Our Experts Do The Legwork – Your Tribe Collects Savings
Repricing Medicare claims can save your Purchase Referred Care (PRC) formally known as Contract Health Services (CHS) dollars by obtaining repricing of claims from hospitals and facilities that are approved by Medicare.
Effective July 5, 2007
All Medicare-participating hospitals that provide services authorized by Purchase Referred Care (PRC) programs must accept the Medicare rates as payment in full.
Effective May 20, 2016
All non-hospital services for tribal members are eligible for Medicare-Like Rates. This means that claims from physician and other health care professional services (not necessarily hospitals), that accept Medicare, can be repriced to Medicare-Like Rates. This allows your Purchased Referred Care dollars to stretch even further!
Forest County Potawatomi Insurance Department invites you to use our services to reprice hospital and medical claims from participating facilities to Medicare-Like Rates! Please see the complimentary coupon below to use on your first 10 claims.
Why choose the Forest County Potawatomi to reprice your claims to Medicare-Like Rates (MLR)?
- Tribally owned and operated on the Forest County Potawatomi reservation
- Ability to reprice facility and physician services
- Reprice for a low per claim fee rather than a percentage
- Small one time set-up fee
- Our efficient staff has a quick turnaround time
- Experience with repricing claims for numerous tribes throughout the United States
- Expertise in repricing
- Saves your tribe time and money
- Explanation of Reimbursement provided for each claim
- Customer Service support for provider inquiries regarding reimbursements
- Convenient submission of claims by email or fax
- Monthly billing for services including reports to indicate savings
Our Medicare-Like Repricing Customer Savings History
| Year | Number of Claims |
Total CHS Claims |
Repriced Amount |
Actual Savings | % Savings Overall |
|---|---|---|---|---|---|
| Fiscal Yr 09 | 1213 | $3,883,668.60 | $1,359,284.01 | $2,524,384.59 | 65% Savings Overall |
| Fiscal Yr 10 | 9420 | $19,553,400.94 | $6,421,098.54 | $13,132,302.40 | 67% Savings Overall |
| Fiscal Yr 11 | 9734 | $24,094,455.78 | $11,392,115.00 | $12,702,340.78 | 53% Savings Overall |
| Fiscal Yr 12 | 8178 | $29,417,690.02 | $10,074,008.67 | $19,343,681.35 | 66% Savings Overall |
| Fiscal Yr 13 | 7607 | $32,126,432.45 | $9,956,745.65 | $22,169,686.80 | 69% Savings Overall |
| Fiscal Yr 14 | 7753 | $34,289,111.01 | $9,916,867.67 | $24,372,243.34 | 71% Savings Overall |
| Fiscal Yr 15 | 6474 | $29,953,376.52 | $9,154,609.48 | $20,682,787.16 | 69% Savings Overall |
| Fiscal Yr 16 | 17227 | $39,754,314.19 | $12,172,123.41 | $27,582,190.78 | 69% Savings Overall |
| Fiscal Yr 17 | 47796 | $55,696,816.65 | $16.086,888.48 | $39,609,928.14 | 71% Savings Overall |
| Fiscal Yr 18 | 52356 | $72,266,744.32 | $21,865,243.59 | $50,401,500.73 | 70% Savings Overall |
| Fiscal Yr 19 | 49784 | $74,721,074 | $22,620,636.81 | $50,401,500.73 | 70% Savings Overall |
| Fiscal Yr 20 | 68840 | $100,925,024.46 | $27,517,801.89 | $73,407,222.57 | 73% Savings Overall |
| Fiscal Yr 21 | 60922 | $101,447,973.53 | $24,561,229.91 | $76,857,127.33 | 76% Savings Overall |
| Fiscal Yr 22 | 65303 | $97,585,069.99 | $24,534,800.42 | $74,649,548.45 | 76% Savings Overall |
| Totals | 412,607 | $715,715,152.66 | $207,633,453.52 | $509,535,382.62 | 71% Average Savings |
*In March 2016 nonhospital claims became eligible for MLR
Call us today for more info at 715-478-7448
