Formerly known as CHS, the Purchased/Referred Care Department is now settled in to the new name. Business goes on as usual in the PRC Department and as always we are happy to be working for this community. Al-ways striving to work together to better the lives and health of our patients!
What’s the Difference Between PRC and Direct Care?
- Having a “Direct Care” status means that a patient is eligible for services given within the clinic at no cost.
- Having a PRC (Purchased/Referred Care) status means that a patient is eligible for services given within the clinic, as well as to referred to providers, hospital services, pharmacy, outside labs and radiology ser-vices.
Reminders from Patient Registration
- Registration is done on a yearly basis
- Make sure to keep your contact information up to date (Phone number and address ), as it is an important part of patient care.
- Notify if is any change in insurance
- Indian documentation from a federally recognized tribe or BIA.
- Birth certificate
- Social Security Card
- Residence Verification (utility bill)
- Identification Card or Drivers License (current or valid within the residence)
- Alternate Resource (if none, must be screened by our Benefits Coordinator.)
Meet our Benefits Coordinator: Alma Bravo
The Patient Benefits Coordinator is responsible for assisting appli-cants when applying for alternate resources for medical coverage and CalFresh benefits.
The Patient Benefits Coordinator conducts ongoing assessment of unmet social service needs for the TRIHCI service area.
Keep in mind that the Benefits Coordinator can no longer receive update paperwork for Medi-cal re-cipients. This update paperwork is sent directly to the patients home and no other person can do the pa-per work but themselves.
Emergency Visit Report Line (559) 781-5714
If you have to go to an emergency room after business hours please call our phone number to report within 72 hours.
ER visits are only eligible for coverage if the facility visited is at a hospital. Urgent Care is not a covered service.
Purchased/Referred Care Guidelines
- Patient must see a TRICHI provider and be re-ferred for specialty care within levels of care for coverage.
- Patients must notify PRC (CHS) before going to PRC appointments or patient will be responsible for the cost.
- Patients must report emergency services within 72 hours.
- Patients must utilize alternate resources; PRC is payer of absolute last resort.
- Bills/Statements from outside providers must be turned in on a timely manner.
- It is the patient’s responsibility to provide insur-ance information to all their healthcare providers.
Tule River Indian Health Center, Inc. is neither an entitlement program nor a private insurance agency. Do not assume all your bills will be paid automatically by TRIHCI.
How your Bills Get Paid!
Make sure to always provide your non-Tule providers with your in-surance coverage for any and all services. This will minimize the time spent trying to correctly bill your insurance as well as save you from ever being referred to a collection agency
How Referrals Work
- You must use the Pharmacy that your insurance is contracted with, unless told otherwise.
- Some prescriptions require pre-authorization from your insurance or doctor, which can lengthen the time it takes to fill a prescription.
- Allow 2-4 hours for the Pharmacy to receive your prescription.
- If you ever have any issues with your medica-tions please contact us so we may assist you.
- Please be courteous and considerate to our Pharmacy Staff, they handle numerous patients on a daily basis.
What Pharmacy to Use
|Health Net Med-ical||Rite Aid 66 W. Morton Porterville, Ca. 559-788-0452||CVS Pharmacy 53 E. Olive Ave. Porterville, Ca. 559-791-9238|
|Blue Cross (IMG) Medi-cal||Wal-Mart 1250 W. Henderson Ave. Porterville, Ca. 559-783-2090||Target Pharmacy 1363 W. Henderson Ave. Porterville, Ca. 559-719-2204|
|Straight Medical||Walgreen’s 416 W. Olive Ave. Porterville, Ca. 93257||Private Insurance
Walgreen’s 416 W. Olive Ave. Porterville, Ca. 93257