Purchased and Referred Care: An Important Aspect of Your Good Health.
Purchased and Referred Care: An Important Aspect of Your Good Health.
Purchased and Referred Care (PRC): Enhancing Access to Healthcare
The Purchased and Referred Care (PRC) program provides patients with access to specialists or treatment options outside of our health system. This program, formerly known as Contract Health Services, was renamed under the Consolidated Appropriation Act of 2014. PRC funds are used to supplement and complement other healthcare resources available to eligible American Indians and Alaska Natives (AI/AN).
Services Offered by the PRC Department
- Referrals to specialists
- Scheduling appointments
- Paying outside vendors
- Processing payments for services
- Identifying alternate resources
For more details about the PRC process, view our PRC Process Handout.
Understanding the Hospital Chargemaster
Cherokee Indian Hospital Authority (CIHA) is committed to transparency in healthcare services and costs. We believe patients have the right to understand their healthcare options, including the associated costs. Our goal is to make billing, insurance, and medical records easy to navigate.
Cost estimates are based on average payments and payment ranges for specific services. Actual out-of-pocket costs may vary depending on the services received and your applicable insurance benefits or self-pay discounted rates.
Contact Information
For questions or assistance, please contact us during our hours of operation:
Hours:
Monday–Friday: 8 a.m.–4:30 p.m.
Phone: 828-497-9163 ext. 6214
Frequently asked questions:
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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.
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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.
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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.