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TMWIHC

Purchased & Referred Care (PRC) - Formerly Contract Health Service

What is Purchased & Referred Care?

Purchased & Referred Care (PRC) is a limited and restricted program of managed care that can provide funding for services that are not provided by the Tuolumne MeWuk Indian Health Center.

PRC is a program designed to help with medical, dental, and behavioral health financial assistance for verified California Indians or descendants who live in our service area. In order to use PRC services you must use all other resources available to pay for your care – resources such as Medicare, Medi-Cal, and/or private insurance.

In order to qualify for Purchased & Referred Care, you must meet certain eligibility requirements. PRC is a complex program with guidelines and a strict policy of pre-approvals for services. For more information on qualifying for PRC, please contact the Contract Health Specialist at (209) 928-5406

In order to obtain approval for payment of after hours, weekend, or holiday visits to an emergency care facility, all PRC eligible patients must contact the PRC office within 72 hours of the visit to the urgent care facility. If you seek treatment for non-emergency services at a hospital, payment may be denied.  An emergency is not defined by the location where treatment was received and is limited to treatment where life or limb is threatened.

Alternate Resource

You are required by federal regulation to apply for an alternative resource if there is a reasonable indication that you may be eligible.  If you are eligible for an alternative resource and you refuse to apply for or refuse to use that alternative resource you will be denied PRC payments.  The Tribal member is required to fulfill all requests from the alternative resource agency.

PRC is payor of last resort for eligible persons and is not an entitlement program.  The use of alternative resources is Federally mandated


 

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