Purchased Referred Care
Medical or dental care that is provided at Haak’u Health Center is called direct care. The Purchased Referred Care (PRC) program is for medial or dental care provided away from HHC. PRC is for services that are provided by private doctors and hospitals that HHC is unable to provide.
PRC is used in situations when:
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No tribal or IHS direct care facility exists
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Neither IHS or tribal direct care facility is unable to provide the necessary emergency and/or specialty care
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A patients alternate resources do not fully cover the total cost of the care that the patient may need. Please see in FAQ on an explanation of “alternate resources.”
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The service is deemed to be within the established medical/dental priorities.
The PRC program is not:
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An entitlement program
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An insurance program
After Hours (Emergency)
If you are having an emergency a life-threating emergency, chest pain, shortness of breath, severe abdominal pain, abnormal or severe bleeding, or a life-threating injury.
1: Call 911 or visit the emergency room. Emergency rooms are for true emergencies, not for care that can be provided by one of our primary care doctors or because it is more convenient. Use the of emergency room will be reviewed for the urgency of the service(s)
2: Call PRC (505-552-5343) within 72 hours and leave a message with the following information:
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Your name
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Date of Birth
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Hospital or Clinic Name
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Reason for visit
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Your call back number
3: Call Primary care at 505-552-5300
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You will need to schedule a follow up with your primary care doctor
Some common reasons why PRC may deny payments to an outside provider:
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No prior notification/authorization of service
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No 72-hour notice for an ER/Urgent Care visit
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Failure to notify PRC of any upcoming appointments
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No medical record established at HHC
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Not PRC eligible based on PRC eligibility guidelines
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Emergency room or ambulance was used for a non-emergency
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Service is not within the current medical or dental priority level
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The patient is under the custody of police or another state organization.
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Patient left the hospital against medical advice
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The visit was a result of motor-vehicle accident, request for payment needs to be sent to the insurance company first
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If patient has alternate resources, it must be billed to them first.
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Patient failed to apply for alternate resources
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Services could have been provided at HHC during normal business hours
Referral Process
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Your provider will enter a referral in our Electronic Health Record requesting to be referred to a specialist
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Referrals are good for one (1) year
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An assigned referral specialist will process your referral, verify eligibility and determine approval
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It can take up to 14 days to process your referral
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Stat referrals can take up to 2 days to process your referral
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The assigned PRC specialist will contact you with information on where your referral is being sent to and provide the facility phone number
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Your referral will either be mailed to you or will need to be picked up in the office
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It will be your responsibility to call to schedule an appointment for your referral
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Once you have an appointment schedule, you will need to call PRC so they can update your referral
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For changes in appointment days, any additional appointments, testing or other services, a secondary referral will be created, and you will still need to notify PRC of ALL appointment
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If you have any problems scheduling your appointment please contact us at 505-552-5343 or your assigned PRC Specialist.
If you are being referred to a specialty care provider and do not hear back from us within 21 days, please contact your PRC Specialist or our main line at 505-552-5343
Patient Should Bring the Following to Their Appointments:
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A copy of the referral from PRC
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Copies of any third-party insurance cards such as Medicare, Medicaid, Private Insurance, etc.
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Copies of x-rays and/or CT scans and/or reports