A solution for all self-funded clients.
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After a claim is submitted to UMR, and the member’s eligibility and tribal affiliation is verified (maintained in our system), we coordinate the process to reprice the claim at MLR. Contracted providers are not required to bill at MLR, however, they are required to accept payment at MLR if the facility is a Medicare participating hospital.
Claims for services not eligible for MLR are paid at network discounted rate.
Our online reporting tools allow you to identify claims paid at MLR and review information on benefit utilization, financial activities, network performance and enrollment.