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Employee Benefits // Health Administration / Employee Benefits & Member Services

TribalCare Administration offers affordable rates, extensive service, and access to the nation’s leading health networks. This comprehensive platform connects your members to a first class healthcare experience that places their needs at the forefront. 

  • Claims administration
  • Purchased/Referred Care (PRC), formerly Contract Health Services (CHS), Support Services*
  • Medicare-Like-Rates (MLR) implementation and enforceability 
  • Sponsorship candidate identification, enrollment, and coordination
  • Payer of last resort administration and coordination  
  • Catastrophic Health Emergency Fund (CHEF) identification, claim preparation/submission, and claim flow
  • Integration with tribal health facilities
  • Integration with best-in-class networks
    • Aetna
    • Anthem
    • Blue Cross Blue Shield of Arizona
    • Blue Cross Blue Shield of Minnesota
    • Blue Cross Blue Shield of Nebraska
    • Blue Cross Blue Shield of North Dakota
    • Cigna
    • Health Care Service Corporation (Blues of Montana, New Mexico, Oklahoma, and Texas)
    • Premera (Alaska and Washington)
    • Wellmark (Blue Cross Blue Shield of South Dakota and Iowa)
  • End stage renal disease prevention and cost containment services
  • Dialysis programming
  • Comprehensive care management
  • Disease management and predictive population management 
  • Single-platform reporting and analytics
  • Dedicated platform exclusively servicing Native Americans
  • Compliance ERISA/Indian Health Law expertise

*MLR implementation/enforcement