A Unique Medicare Advantage Plan Type
The Lasso Healthcare MSA combines health coverage with a special medical savings account. We deposit money from Medicare into the member’s savings account. The member decides what health services to spend it on.
3 Easy Steps to Getting Paid
For services provided to patients with an MSA, the reimbursement process follows other Medicare Advantage plans not requiring co-pays or co-insurance at time of service.
- Submit your claim to us via our clearinghouse; info available below and on the back of the member's ID card.
- We return Medicare-allowable pricing to you, along with any payment due from us and any member liability amount.
- Bill the member directly for their liability. The member chooses to pay with their available MSA funds or out-of-pocket.
Medicare Advantage with Access Like Original Medicare
CMS designed MSA plans to be consumer-driven, with open clinical access to all Medicare providers and reimbursement just like Original Medicare. Members can access any Medicare provider. Thousands of providers already accept the Lasso Healthcare MSA, including some of the largest and most renowned systems. Claims submission does not require a contract and works like an out-of-network PPO benefit.
We reimburse the lesser of the billed charges or 100% of the Medicare FFS rates. Medicare-covered services count toward the member's deductible.
We reimburse 95% of the Medicare allowable amount. Where allowed by state law, you may bill up to a “limiting charge” which is above Medicare-approved rates. For Medicare-approved services, the base charge will count toward the deductible, however, the limiting charge will not be reimbursed by us, nor will it count toward the member deductible.
Charges are based on a private contract between you and your patient/our member. No services will be reimbursed by us, nor will the services count toward the member deductible.
Delivering Great Care to an MSA Member
Patients with MSAs tend to consume health services differently than patients with traditional plans. Here are some suggestions for partnering with MSA patients.
Establish an Annual Care Plan
See the member at least once a year, and help them establish a plan that can guide them in managing their health.
Execute on the Care Plan
Help the member focus services on preventive versus corrective.
Consider Sharing Information
Consider utilizing clinical sharing platforms such as OpenNotes.org(opens in a new window)
Make them an informed consumer
Navigating the health system can be a challenge, so consider educating your patients with tools like ChoosingWisely.org(opens in a new window)
Frequently Asked Questions
We've answered some common questions below. If you have a question we haven't yet answered, please contact our Provider Service team at 800-579-0254.
We do not contract with Lasso Healthcare. Can we submit claims for reimbursement?
Yes! CMS prohibits us from restricting clinical access, so we have no "network" or "contracted providers" like other Medicare Advantage plans. Thousands of providers already accept the Lasso Healthcare MSA, including some of the largest and most renowned systems. Claims submission does not require a contract and follows the same process used to submit out-of-network PPO claims.
What does CMS say about provider reimbursement for MSA plans?
Medicare beneficiaries with an MSA may access any Medicare provider. Insurance companies offering MSA Plans cannot limit an MSA member’s provider choice. Insurance companies offering Medicare MSA Plans are required to pay as Medicare pays. If a provider accepts assignment as Medicare-participating, reimbursement is the lesser of billed charges or 100% Medicare allowable amount. If a provider is non Medicare-participating, reimbursement is 95% of the Medicare allowable amount with balance billing of the member (where allowed by state law) allowed up to 15% of the non-participating Medicare allowable amount.
The member told me they haven't yet reached their plan deductible. Since I know he/she is liable for payment ahead of time, do I need to submit a claim to you or can I just bill the member directly?
Please submit the full claim to us first so we can better track the member’s progress to their deductible.
A member wants to pay their liability amount with their MSA debit card, but we do not accept credit or debit cards. What should the member do?
Members can pay in a form you do accept, such as personal check or cash, and then reimburse themselves from their medical savings account with no additional tax liability.
Does your plan require any pre-authorizations or notifications for services?
No, we do not require any pre-authorizations or notifications.
Where do I send claims to?
Claims can be submitted via our online clearinghouse or mail.
Online: https://goo.gl/FCxy3m(opens in new
window) (online payer ID# 10550)
Mail: P.O. Box 261709, Plano, TX 75026
Do you have a printable guide with the information discussed on this site?
Our printable provider guide is available hereprovider guide (opens in a new window).