'CHS' Changes Name to 'Purchased and Referred Care'

by Kristina Kuykendall, PRC Staff Member Lac Courte Oreilles Health Center

Purchase & Referral Care (PRC) has service offices on both levels of the LCO Heath Center. In the lower level, Neomi Corbine works mainly with incoming medical claims and billing. She can assist patients with questions and concerns about any medical billing that they may receive. In the upper level, located next to the dental office, is Kristina Kuykendall. She is the first point of contact for a medical referral. The LCO Health Center has made this division within the PRC office to better serve patients. Kristina's new location in the clinic provides a closer interaction with the medical staff and patients alike.

Services that will be covered by PRC are key factors to the referral process. A Medical Referral and a Purchase Order for services are two very different services. With the closer interaction between PRC and Medical staff, the LCO Health Center can help get patients information about their referral for outside services in a timely manner. The priority of patient need for outside services can be determined for coverage of PRC. In most cases this can be completed before the patient leaves from their LCO Health Center appointment.

Medical/dental care provided at the LCO Health Center is called Direct Care. The PRC Program is for medical/dental care provided outside of the LCO Health Center. PRC is not an entitlement program and an IHS referral does not imply the care will be paid. If IHS is requested to pay, then there will be eligibility and a determination process to see if services will be covered. A patient must meet the residency requirements, notification requirements, medical priority, and use of alternate resources. Please remember that a new referral is needed for each visit.

Also located in the upper level of the clinic, is the patient registration service. PRC must work directly with this department to determine the eligibility requirements mandated by the IHS.

It is crucial that this department has the most recent and up-to-date information regarding patients. Without this information in place, it is possible that a PRC request for coverage can be denied because of registration issues.

The PRC and all other department staff are available for questions at the main clinic number (715) 638-5102. PRC staff members can be reached directly at (715)638-5109 for Kristina and (715) 638-5129 for Neomi.