Indian Health Service can take over a year to process contractor payments

Dec 13, 2013

A study by the Government Accountability Office – or GAO - shows that it takes over one year for the Indian Health Service to process payments to contractors in 8-percent of claims.

The Indian Health Service provides limited medical services to tribal members and outsources other treatments through the contract health services program. The GAO’s Kathleen King says some payments are delayed because decisions about whether IHS will pay for a service are made on a case-by-case basis. 

“The Contract Healthcare Services program is really unlike other health insurance programs because it does not have, for example, defined eligibility and it does not have defined benefits,” King says. “Eligibility depends upon an individual set of circumstances and also the medical condition that the person is seeking treatment for.”

The Billings office, which covers Wyoming, pays over 90-percent of claims within a year and nearly 50-percent of claims within 3 months of service delivery. That’s a higher rate than most other offices in the U.S.

The report says the Affordable Care Act could help streamline eligibility requirements for contract health services and free up some IHS funds.