Purchased and Referred Care: An Important Aspect of Your Good Health.

As the name suggests, Purchased and Referred Care (or PRC, for short) provides our patients with valuable referrals to specialists or treatment options outside our health system. (The Consolidated Appropriation Act of 2014 changed the name of the Contract Health Services program to the Purchased and Referred Care program.) PRC funds are used to supplement and complement other healthcare resources available to eligible American Indians and Alaska Natives (AI/AN).

The Department Offers the Following Services:

  • Referrals
  • Scheduling appointments
  • Paying outside vendors
  • Vetting payments for services
  • Alternate resources


Hours of operation:
Monday–Friday: 8 a.m.–4:30 p.m.
828.497.9163 ext. 6214

Frequently asked questions:

  • I am eligible for healthcare from the Indian Health Service, but the local Service Unit will not pay for the surgery, healthcare, or medicine that I need—why?

    Care outside the Cherokee Indian Hospital Authority is called Purchased and Referred Care. PRC has various requirements for qualification. To be eligible for PRC, you must:

     

    • Be 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 you are not a member of the EBCI, then you 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 EBCI.

     

    The basis for determining a person’s close economic and social ties is established by the Tribe and may include considerations such as:

    • Whether the person is employed by the EBCI.
    • Whether the person is married to, or is the child of, an eligible member of the EBCI.
  • Why hasn’t PRC paid my bill?

    PRC strives to pay every bill in a timely manner. Some obstacles to prompt payment are as follows:

     

    • The patient does not have a referral from a Cherokee Indian Hospital Authority (CIHA) provider prior to receiving services.
    • The patient has not complied with alternate resources.
    • The patient’s chart is not complete.
    • An outside provider has not sent the claim to CIHA.
    • The patient does not bring statements from his or her outside provider to PRC.
  • Where or how do I get a referral for healthcare?

    Referrals can be processed in several ways:

     

    • A primary care or emergency room provider issues the referral.
    • The Managed Care Committee, which consists of doctors, nurses, and PRC staff, reviews and approves the patient for referral.
    • In the event of an emergency situation, the patient must call his or her primary care team within 72 hours of receiving care.
      • Elders must call in emergency situations within 30 days of receiving care.

     

    Please note that referrals may be denied if it is determined that the requested services could have been provided through CIHA.

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