The Contract Health Services Program or Purchased/Referred Care (PRC) program assists patients in managing their health care when a referral to see a specialist is determined to be beneficial to obtain optimal medical care.
There are two types of referrals to see a specialist; covered and non-covered referrals.
Covered: A referral which is provided by a PBPHC physician and meets all Contract Health Services eligibility criteria listed below:
- Meets Medical Priority Level approved by the Contract Health Services Program.
- Residence in the Contract Health Services Delivery Area (CHSDA). The designated CHSDA includes Contract Health Services resources for Prairie Band Potawatomi Nation tribal members residing in Jackson and Doniphan counties in Kansas and Richardson County in Nebraska; and resources for non-indigenous tribal members residing within Jackson County. Resources for members of the Kickapoo Nation of Kansas, Sac and Fox Tribe of Missouri in Kansas and Nebraska, and Iowa Tribe of Kansas and Nebraska are not included in the CHSDA.
- An active patient of the Health Center.
- Availability of funds for the Contract Health Services Program.
Non-Covered: A referral which is provided by a PBPHC physician and is an important part of the treatment plan; however, Contract Health Services will not financially cover the expense for the referral because it does not meet all the eligibility criteria.
Contract Health Services Program is the payer of last resort and payments will not be made until all other financial resources have been utilized.
Contract Health Services Coordinators assist patients in seeking and completing applications and enrollment forms for insurance benefits coverage such as: Medicare Parts A (hospital coverage) , B (medical coverage) and D (Prescription Drug Coverage), Medicaid/Healthwave, Veteran's benefits, Workmen's Compensation, private insurance, etc.
For more information call 785-966-8282.