What is Purchased Referred Care (PRC)?
The Winslow Indian Health Care Center Purchased Referred Care team tries to help patients get access to health care that aren't offered at WIHCC. Medical care provide here at this facility is called Direct Care. PRC receives a limited amount of funding from Indian Health Service (IHS) to pay for special health care needs that are not available at WIHCC or in the IHS. WIHCC PRC manages the PRC funds carefully in order to make sure funds are available to as many people as possible, for as long as possible, If PRC cannot pay for needed health care, we try to help the patient find an alternate payer, or find the needed services within the Indian Health Services (IHS).
The Winslow Indian Health Care Center Purchased Referred Care team tries to help patients get access to health care that aren't offered at WIHCC. Medical care provide here at this facility is called Direct Care. PRC receives a limited amount of funding from Indian Health Service (IHS) to pay for special health care needs that are not available at WIHCC or in the IHS. WIHCC PRC manages the PRC funds carefully in order to make sure funds are available to as many people as possible, for as long as possible, If PRC cannot pay for needed health care, we try to help the patient find an alternate payer, or find the needed services within the Indian Health Services (IHS).
PRC Wants to Help
PRC wants to help you get access to needed health care, help patients avoid problems with medical bills and understand what to do next if Purchase Referred Care cannot pay their medical bills.
PRC wants to help you get access to needed health care, help patients avoid problems with medical bills and understand what to do next if Purchase Referred Care cannot pay their medical bills.
Not everyone is eligible for PRC.
- The care must be pre-approved by PRC (except for emergencies).
- It is important to find out from PRC who is going to pay your bill before you get health care outside of WIHCC or the IHS. If you don't get prior approval you may have to pay your own bill.
- PRC is only available to eligible patients as long as funds are available.
What you need to know...
Patients need to know not everyone is eligible for PRC. Eligibility is determine by federal regulations which included 6 criteria that must be met to be eligible. The following criteria are listing below.
INDIAN DESCENT
To be eligible, the patient must be a member of a Tribe or Tribes serviced by the local Purchased Referred Care delivery area.
RESIDENCY
The patient must live in the WIHCC PRC delivery area. If the patient is living out of the area for more than 180 days, he or she is no longer eligible.
MEDICAL PRIORITY
The health care requested must meet Navajo Area Indian Health Services (NAIHS) established medical priorities.
- Not all services are covered.
- Occasionally health care professional refer patients for specialties and services that are important, but are not necessarily covered under the NAIHS medical priorities.
- Going to a non-IHS hospital Emergency Department on your own, for something that is not an emergency (like a cold) does not meet medical priority.
NOTIFICATION / PRIOR AUTHORIZATION
- NON-EMERGENCY CARE - The patient/guardian needs to get prior approval from PRC for any scheduled appointments outside WIHCC (tests, elective surgery, specialist appointments).
- EMERGENCY CARE - The patient, or someone on their behalf must notify PRC within 72 hours after the beginning of treatment for emergencies.
ALTERNATE RESOURCES AVAILABLE
PRC is the payer of last resort by regulation.
- If there is any chance the patient is eligible for Medicaid (AHCCCS), they must apply before PRC can consider payment.
- If a patient can receive private insurance through their work, WIHCC recommends they do so. Some Tribal Self-Insurance plans may be an exception to this suggestion. Tribal Self Insurance such as HMA or SRT have unique rules that you should know about before assuming they will pay your bills.
- Patients who are 65 or older should apply for Medicare A and B, which will pay for services covered by those Medicare plans. Medicare and AHCCCS cover more services than PRC does.
APPROPRIATE ORDERING OFFICIAL
- A WIHCC health care provider must make your referral (except for emergencies). Patients cannot refer themselves to specialists, or be referred by private doctors to other private doctors and be elgible for PRC funds.
- A WIHCC provider medical referral is a request for health care services, NOT a guarantee of payment by PRC.
- The request for referred health care services comes from a doctor or nurse practitioner who works for WIHCC. The decision of eligibility and payment comes from WIHCC PRC.
- A referral from WIHCC provider is required to be eligible for PRC. However, you must meet all of the other 5 criteria to be eligible for PRC funds.
What health care am I eligible for?
- DIRECT CARE: If you are Native American from a federally recognized Tribe, you can get direct health care at most I.H.S or Tribal Health Programs without a cost to you.
- REFERRED CARE: This is also known as Purchased Referred Care. If you need health care that a direct care program can't provide and a health care professional has to refer you to an outside specialist, this is called Referred Care.
PRC STAFF - available to help you.
Support assistants
PRC Support Assistants provide support to Contact Representatives.
| Haneelia Begay | Phone Number: (928) 289-1841 |
| Sabrina Navarro | Phone Number: (928) 657-1154 |
| Rose Nez | Phone Number: (928) 657-1144 |
| Cornelia Wilson | Phone Number: (928) 657-1135 |
| Journee Yazzie | Phone Number: (928) 289-6107 |
Referral coordinators
A Contact Representative will provide you assistance. Below is a listing of the Contact Representatives. You may call anyone of the representatives who are willing to provide you additional instructions or assist you in anyway. Thank you for the opportunity to serve you.
| Wynter Dacawyma | Team 1 | Phone Number: (928) 657-1157 |
| Aundra Lee | Team 2 | Phone Number: (928) 657-1156 |
| Tanya Nells | Team 3 | Phone Number: (928) 289-8076 |
| Merlinda Lansing | Team 4 | Phone Number: (928) 657-1153 |
| Winterfred Yazzie | Sage/Juniper | Phone Number: (928) 657-1151 |
| Marcella John | No PCP | Phone Number: (928) 289-8004 |
| Jennifer Yazzie | ER/Inpt | Phone Number: (928) 289-8094 |
| Colleen Monroe | Vendors | Phone Number: (928) 657-1152 |
Health system specialists
| Amber Clark | Team No PCP | Phone Number: (928) 657-1178 |
| Alicia Parker | Teams 1 & 3 | Phone Number: (928) 289-6282 |
| Grace Yazzie | Teams 2 & 4 | Phone Number: (928) 289-6109 |
| Jamielynn Begay | Teams Juniper/Sage | Phone Number: (928) 657-1158 |
case managers
| Molly Brown, RN | Outpatient Case Manager | Phone Number: (928) 289-1888 |
| Anna Hairrell, RN | Inpatient Case Manager | Phone Number: (928) 289-6182 |
| Jennifer Havlicek, RN | High Risk Case Manager | Phone Number: (928) 289-9098 |
PRC Contact Information:
|
Winslow Indian Health Care Center
Purchased Referred Care 500 North Indiana Avenue Winslow, Arizona 86047 |
WIHCC Fax Number: (928) 289-5668 / 6294 / 8144
DMC Fax Number: (928) 657-1159 ER/Hospital Notification Line: (928) 289-8094 Appointment Notification Line: (928) 657-1144 |
PRC Supervisor's Office:
Ashley Demaria (928) 289 - 6207 |
