Medicare-Like Rate (MLR) Repricing Service

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!

  • Total Savings $128,826,735
  • Total Paid $64,366,077

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
Average Claim $3,564.70
Average Savings $2,378.41

Our Medicare-Like Repricing Customer Savings History

Fiscal Year Number of
Claims
Total CHS
Claims
Repriced
Amount
Actual Savings % Overall
Savings
2009 1213 $3,883,668.60 $1,359,284.01 $2,524,384.59 65%
2010 9420 $19,553,400.94 $6,421,098.54 $13,132,302.40 67%
2011 9734 $24,094,455.78 $11,392,115.00 $12,702,340.78 52%
2012 8147 $29,147,690.02 $10,074,008.67 $19,073,681.35 65%
2013 7043 $32,126,432.45 $9,956,745.65 $22,169,686.80 69%
2014 7753 $34,289,111.01 $9,916,867.67 $24,372,243.34 71%
2015 6360 $29,953,376.52 $9,154,609.48 $20,798,767.04 69%
2016 4495 $20,034,004.83 $6,091,348.77 $14,053,329.42 70%
Grand Totals 54165 $193,082,140.15 $64,366,077.79 $128,826,735.72 66%

Call us today for more info at 715-478-7448