Providers

Lasso Healthcare is a Medicare Advantage plan offering a Medicare Medical Savings Account (MSA) to individuals looking for a flexible approach to their Medicare spending.
unique MSA plan type

A unique Medicare Advantage plan type

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.

Original Medicare... plus!

CMS designed MSA plans to be consumer-driven, and have clinical access and reimbursement work exactly like Original Medicare.

Submit your claim

Required to see the member if accepting new patients.

Submit your claim

Charges are based on a private contract between you and our member.

Submit your claim

Medicare-covered services count towards member's deductible.

You are not required to see our members

You are not required to see our members.

Where allowed by state law

Where allowed by state law, you may bill up to a “limiting charge” which is above Medicare-approved rates.

For Medicare-approved services

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.

You are not required to see our members.

You are not required to see our members.

Charges are based on a private contract

Charges are based on a private contract between you and our member.

No services will be reimbursed by us

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

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

Execute on the Care Plan

Help the member focus services on preventive versus corrective.

Consider Sharing Information

Consider Sharing Information

Consider utilizing clinical sharing platforms such as OpenNotes.org

Make them an informed consumer

Make them an informed consumer

Navigating the health system can be a challenge, consider educating your patients with tools like ChoosingWisely.org

Frequently Asked Questions

We've answered some common questions below. Have a question we haven't yet answered? Please contact our Provider Service team.

Remember, Lasso Healthcare is prohibited by CMS from restricting clinical access for our members, so we have no “network” or “contracted providers” like other Medicare Advantage plans. You are required to see the member if you are a Medicare-participating provider and accepting new patients. Non-par and opt-out providers are not required to see the member.

MSA Provider Reimbursement – 42 C.F.R. §§ 422.103 and 422.214

  • Medicare beneficiaries with an MSA may access any Medicare participating provider. Insurance companies offering MSA Plans cannot limit an MSA member’s provider choice.
  • 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 and decides to see the MSA member, 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.
  • Insurance companies offering Medicare MSA Plans are required to pay as Medicare pays, including bad debt reimbursement per Medicare guidelines.

Engagement and Information Sharing – 42 C.F.R. § 422.103(e)

MSA members need clinical support and engagement to help navigate health care service options and associated cost analysis. Insurance companies offering Medicare MSA Plans are required to support MSA members through cost transparency information and tools that assist with informed knowledge about healthcare service options. These tools are designed with a goal to support better clinical and patient engagement, care plan development and execution. MSA members are encouraged to perform pre-work, then seek your clinical counsel on how best to manage their health and healthcare choices in a smart and cost-effective manner.

Please submit the full claim to us first so we can better track the member’s progress to their deductible.

Members can pay in a form you do accept, such as personal check or cash, and then reimburse themselves from their MSA bank account with no additional tax liability.

No, we do not require any pre-auths or notifications.

Claims can be submitted via our online clearinghouse or mail.

Online: https://goo.gl/FCxy3m (online payer ID# 10550)
Mail: P.O. Box 261709, Plano, TX 75026

Our printable provider guide is available here.

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