Authors: NCUIH

Publication Year: 2023

Last Updated: Fall 2023

Keywords: Health Care Access, Medicaid/Medicare, Other

Abstract: This report serves as an update to the National Council of Urban Indian Health’s previous reporting on recent trends in third-party billing. This report focuses on the experience of urban Indian organizations enrolled in Medicaid and the Children’s Health Insurance Program as a primary care case manager (PCCM) or Indian Managed Care Entity (IMCE).

Key findings related to UIO Experience with PCCM/IMCE:

Benefits for UIOs and patients included:

• PCCM services improved continuity of care for Medicaid and CHIP enrollees
• UIOs have a comprehensive view of the patient’s care, reducing need for self-advocacy and reporting

Best practices included:

• Strong working relationships with state Medicaid offices and Tribal Relations Liaisons, and other partners
• Use of state Urban Confer and/or incorporation of UIOs into state Medicaid Tribal Consultations

Challenges included:

• Insufficient capitation rate for UIOs providing PCCM services
• Poor communication with state Medicaid offices
• Lack of 100% FMAP for UIOs resulting in UIO exclusion from PCCM program

Source: Link to Original Article.

Source: https://ncuih.org/research/third-party-billing/#tab-id-1

Type of Resource: NCUIH products (infographs, urban data reports, etc..)