The PRC department provides referrals to outside medical providers. In January 2014, the Consolidated Appropriation Act of 2014 renamed the Contract Health Services program to the Purchased/Referred Care (PRC) program. The PRC funds are used to supplement and complement other health care resources available to eligible American Indians and Alaska Natives (AI/AN).
The department offers:
2. Scheduling appointments
3. Paying outside vendors
4. Vetting payments for services
5. Alternate resource
Hours of Operation - Monday thru Friday 8:00am to 4:30pm
For more information please call: (828) 497-9163 ext. 6214.
Frequently Asked Questions
Q: I am eligible for health care from the Indian Health Service, but the local Service Unit will not pay for the surgery, health care, or medicine that I need? Why?
A. Care outside of the Cherokee Indian Hospital Authority is called Purchased and Referred Care (PRC). PRC has different requirements, to be eligible for PRC you must:
• Eligible for Direct Care
• Live within the Contract Health Service Delivery Area (CHSDA): Jackson County, Swain County, Cherokee County, Haywood County, and Graham County
• Be a member of the EBCI
• If not a member of the EBCI, then must be a member of a federally-recognized Tribe and Live on Indian (reservation) land
OR live within the CHSDA and maintain close economic and/or social ties to the Tribe
• The basis for determining a person’s close economic & social ties is established by the tribe & may include:
- The person is employed by the EBCI
- The person is married to or is the child of and eligible member of the EBCI
- The person works for the EBCI
Q: Why haven’t you paid my bill?
- A: PRC strives to pay every bill timely. Some obstacles are listed below.Patient does not have a referral from a Cherokee Indian Hospital Authority (CIHA) provider prior to services.
- Patient has not complied with alternate resource.
- Patient’s chart is not complete.
- Outside provider does not send the claim to CIHA.
- Patient does not bring statements from outside provider to PRC.
Q: Where do I get a referral?
A: Referrals can be processed several ways:
- Primary care/Emergency Room provider enters referral.
- The Managed Care Committee which consists of doctors, nurses, and PRC staff reviews and approves.
- Patient calls in an emergency situation within 72 hours
- The Managed Care Committee reviews and approves.
- Referrals may be denied if it is determined that services could have been provided at CIHA