Purchased Referred Care

What is Purchased/Referred Care?

Formally known as Contract Health Services, Purchased/Referred Care (PRC) is a benefit to American Indians and Alaskan Natives that provides funding for referred medical services not available at an IHS or tribal facility.

Emergency Notification

Notification must be provided within 72 hours of discharge or admission by calling PRC direct at (928) 475-1298. If after hours, please leave a message with the following:

1. Name/Date of Birth

2. Phone number

3. Date of emergency

4. Facility where you were seen

5. The reason or diagnosis

6. Mode of transportation

*PRC is not an insurance not a guarantee of payment.

Alternate Resources

PRC is considered the “payor of last resort”. The use of alternate resources is required when such resources are available and accessible to the individual, such as

1. Medicare A and B

2. State Medicaid (AHCCCS/ALTCS)

3. State or other federal health programs

4. Private insurance, etc.

5. IHS or Tribal health facilities

6. Workman’s Comp

For assistance with applying for alternate resources, please contact your Patient Benefit Coordinators at San Carlos Apache Healthcare Corporation (928) 475-1476 or (928) 475-1404. and/or at Clarence Wesley Health Center at (928) 475-7141.

Frequently Asked Questions

Why are Indian descendants not eligible for CHS off the reservation?

Indian descendants residing off the reservation may be eligible if they meet certain conditions. If not residing on the reservation, such individuals must live within the CHSDA and (1) be members of the tribe(s) located on the associated reservations or (2) “maintain close economic and social ties with that tribe(s).”

If a SCAHC doctor refers me to a specialist, why am I being held responsible for the bill?

Referrals are not a guarantee for payment. Referral is a recommendation for treatment/test only. The PRC committee must review the referral to make the determination for PRC approval of payment. All PRC eligibility requirements must also be met.

Do I need a referral for every appointment scheduled with a specialist outside of SCAHC?

YES. If you are scheduled with a specialist that SCAHC providers referred you to, you are responsible for contacting PRC with appointment details. The referral will be presented to the PRC committee for approval. You should always pick up a referral before you go to your scheduled appointment to avoid denial of payment.

If PRC is requested to pay for outside services, patients must be eligible for direct care and meet the following requirements: