The Medicare-Like-Rate program applies to only in-patient and certain out-patient claims. This may represent only half of your actual PRC spend. What do you do to receive deep discounts on those claims that the MLR Program doesn’t touch, such as physicians, specialists, dialysis centers, advanced diagnostic centers, etc?
PRC regulations allow you reprice HCFA 1500 claims at Medicare allowable rates. MLR Tribal Solutions, LLC will ensure you are maximizing the discounts you are allowed. And, though physicians technically do not have to accept this discount, we direct the physicians to contact us, and we work as your advocate to negotiate an appropriate payment.