Purchased Referred Care (PRC)
Purchased Referred Care exists to supplement or complement other health care resources available to Native Americans. PRC funds are used when no direct care exists or is not capable of providing required emergency and/or specialty care.
Individuals residing in Tribal Purchased/Referred Care area on tribal jurisdiction, trust land, and the counties that border the tribal area.
Other requirements include: Students who are temporarily absent from the area, travelers who are temporarily absent from the area due to travel or employment purposes, children in foster care, other Native Americans who are in the area.
Authorization for the referral is reviewed by the Managed Care Committee who will determine medical priority.
*Individuals must apply for alternate resources, such as Medicare A and B, state medicaid, any state health programs, private insurance, if eligible, etc.
PRC (IHS) funds are considered the last resort for payment of services needed.
The new policy is once a patient has been approved for a referral, the patient has 30 days to have scheduled and gone to the appointment for said referral. Once approved, it is now the patient's responsibility to schedule/reschedule their own appointment. If you miss the appointment and DO NOT reschedule that appointment within 30 days, the referral will be closed.
Pawnee PRC is sending several denial letters to vendors and patients due to inactive Pawnee Charts/Pawnee Benefit Program Package (PBPP). Pawnee PRC will mail the patient a letter and the patient has 14 days to respond. If no response within 14 days, the referral will be closed.
PRC's goal is to have approved referral packets faxed within 24 hours of approval for scheduling. Within the first 10 business days, we strive to have an appointment for the referral scheduled. It has become necessary for Pawnee PRC to close referrals if patients contact information and addresses are not up to date. Once you have an active Chart/PBPP, Pawnee recommends the patient call Patient Registration and update yearly to ensure your PBPP/Chart do not become inactive. It is a vital part of the referral process for patients to keep their Pawnee Charts and PBPP up to date.
We understand the importance of our patient's medical and healthcare needs. We will do our part to provide quality medical services to our patients. The patient must do their parts as well by keeping their charts and PBPP up to date.
***ALL PATIENTS who have referrals through Purchased Referred Care (PRC)
Once a patient's referral has been approved, it is REQUIRED BY PAWNEE that the patient goes to the appointment for said referral within 30 days. If you do not make it to your appointment and DO NOT reschedule your appointment within 30 days, Pawnee will close the referral. If you do not have an active Chart and up to date Pawnee Benefit Package Program (PBPP) at Pawnee Health Center and are approved for a referral, you will have 14 days to update or complete the application or you will have to start the referral process over.
***Starting 03/01/2019, EVERY patient who is receiving services at the White Eagle Health Center must also have an active chart/PBPP at Pawnee.
***Before turning in a Pawnee Chart/PBPP application:
- Make sure everything is filled out completely - (if not applicable, put N/a)
- You will need to have your CDIB, a picture ID, and any insurance you may have (if you do not have insurance, please see Patient Benefits)
- A copy of the most current utility bill proving residency (gas, electric, water, lease agreement, cable, etc.) If the bill is not in your name, you will need to have the Notarized Certification (page 2 of the PBPP app) filled out by the person whose name is on the bill and notarized.
- We have a notar on site at the WEHC
If you are unsure about your Pawnee Chart/PBPP or have any questions, please see Patient Benefits or you may call PBPP enrollment (918) 762-6507
Kay Grant
Patricia Roy
Kylee DeLaGarza
Crystal Thornton
