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Purchased/Referred Care (PRC)
PRC
Welcome to the Warm Valley Health Care Purchased/Referred Care (PRC) website. This website was created to provide information to American Indian/Alaska Native (AI/AN) patients on the PRC program requirements for medical/dental care.
Medical/dental care provided at a tribal health care facility is called Direct Care. The PRC Program is for medical/dental care provided away from a tribal health care facility. PRC is not an entitlement program and a referral does not imply the care will be paid. If WVHC is requested to pay, then a patient must meet the residency requirements, notification requirements, medical priority, and use of alternate resources.
All AI/AN should be aware of the following requirements each time he/she is referred or requests WVHC to pay for medical care away from a tribal health care facility.
- Patient responsibility to comply with PRC requirements
- Purchased/Referred Care (PRC) is not an entitlement program
- PRC Eligibility Requirements
- PRC Notification Requirements
- PRC Patient Process for Authorization for Payment Diagram [PDF - 282KB]
- Medical/Dental Priority of Care
- Use of Alternate Resource
(Medicare, Medicaid, VA, Private Insurance, charity, etc.) - Appeal Process for Denial of PRC
- Patient Rights & Responsibilities
- Directory for an IHS or tribal health care facility near your location
The Frequently Asked Questions (FAQ) section gives answers to the most commonly asked questions regarding the PRC program.
The PRC program requirements are based on specific legislation, Federal regulations, policy, and guidelines to maintain the needs of AI/AN.
Read the Understanding the Purchased/Referred Care (PRC) Program: Parts 1-6 on the Director's Blog.
Photo
From left to right, Courtney Hill, Janessa Azure, Renee Enos
UPDATE PRC
PRC
PRC (Purchased Referred Care) The PRC
program at Warm Valley Health Care (WVHC) is for medical/dental care provided away from WVHC facility.
PRC is not an entitlement program and a WVHC medical referral does not imply the care will be paid.
If WVHC is requested to pay, then a patient must be PRC Eligible. Provide proof of Tribal Affiliation, meet the residency requirements, meet medical priority currently being funded by WVHC, and use of alternate resources (including WVHC).
NOTE: Eastern Shoshone Tribal member’s referrals that originate from any of the three Wind River Family & Community Health Care facilities will be reviewed for payment at the Warm Valley Health Care PRC program.