James Dunham BS, MHA, MBA

Director, Revenue Cycle
Management Services

Scott Farnsworth BS, MHA, MS

Vice President of Operations

Dale Pinkerton RN, BSN

Vice President,
Nursing Consulting Services

John Dunham RN, BS, MHA

Executive Director,
Care Coordination/Clinical Integration

Lyndsay Farnsworth RN, BSN

Director, Nursing Consulting Services

Michele Mann

Director, Business Development

Jenny Ghost Bear

Opening Prayer and Song
North American Tribal Organization
3314 Lynnwood Ave
Rapid City, SD 57701

Utilization Review Services

Utilization Management has evolved from the Utilization Review process into a comprehensive system not only to evaluate the appropriateness of care using defined severity of illness and intensity of service criteria but to monitor expenses and resources as well as a driver for quality assurance and improvement.

Medical necessity should always be the determining factor when it comes to the appropriateness of medical treatment, with payer constraints and resource allocation ultimately being factored into the equation.

With the advent of the Patient Protection and Affordable Care Act (ACA or Obamacare), government regulators and insurance companies will be attempting to rein in healthcare costs. The Utilization Review process will need to stay on top of regulatory changes for future relevance. Managing resources and ensuring that care is rendered in appropriate settings will continue to be important as well as expanding the focus into preventative care, disease management programs and quality assurance improvement. 

North American Tribal Organization will provide education and review of processes for your organization’s Utilization Review Plan to ensure compliance with the provider's Conditions of Participation contract with Medicare and Medicaid services. Along with Case Management, appropriate Utilization Review ensures appropriate care is provided, cost overrun is avoided, and reimbursement is optimized.