Purchased Referred Care
For additional information on PRC, please see the Patient Handbook.
More Information
What are Direct Care Services?
Medical/dental care provided (in-house) at an Indian Health Service (IHS) or tribal health care facility is called Direct Care.
What is Purchased Referred Care?
The Purchased/Referred Care (PRC) Program at IHS is for medical/dental care provided away from an IHS or tribal health care facility.
How to Access PRC Services?
- Check your eligibility with your local IHS or tribal health care provider.
- Obtain a referral for the required medical or dental services.
- Contact the PRC program to understand the coverage and coordinate care with the referred healthcare provider.
What is a Referral?
Referrals are the formal process of requesting Indian Health Services (IHS) for medical specialists or services that cannot be provided within a particular clinic.
Where is My Referral?
Where Your referral is sent depends upon the following:
- What service/specialty is being requested
- Where you live
- What tribe you are
- What are your third-party resources
If a service/specialty is available within the IHS network, your referral will be sent to that facility for scheduling.
If the service/specialty is NOT available within IHS, your referral will be sent to your IHS catchment area. The federal government issues funding to catchment areas according to their service population.
Your place of residence determines where your referral will be placed. Some tribes provide contract health services to their tribal members as long as they live within their catchment area.
What are Indian Health Services Catchment Areas?
The federal government issues funding to catchment areas according to their service population. Your place of residence determines where your referral will be placed. Some tribes provide contract health services to their tribal members as long as they live within their catchment area.
In general, Catchment Areas are divided by counties. However, there are exceptions. Please call one of our PRC departments to verify your area based on your address.
How do I contact my Catchment Area?
Oklahoma Service Areas can be found here: https://www.ihs.gov/oklahomacity/healthcarefacilities/
** IHS locations outside of Oklahoma can be found here: https://www.ihs.gov/locations/
Third-Party Resources
The Osage Health System accepts Medicaid, Medicare, and private insurance. These referrals will also be processed according to your insurance’s protocol.
Requirement for Referred Care
The patient:
- Must have an active Wahzhazhe Health Center chart and ON PRC Card
- Must be a member of a federally recognized tribe residing in the Contract Health Service Delivery Area (CHSDA)/ also known as Catchment Area.
- Patients must apply for any alternate resources available to them
The referral is then submitted to the PRC Committee for approval. Please direct any questions or concerns to the Purchased Referred Care (PRC) staff at 918.287.9300.
Chart Establishment
A chart MUST be established with your IHS Service Unit, and ALL information must be up-to-date and match the information on the referral, or your referral may be placed on hold.
Chart establishment requires:
- Valid Oklahoma ID or Driver’s License
- Social Security Card
- CDIB
- Insurance Card
- Proof of residency (current utility bill in your name)
** The following information is for Osage Nation Enrolled Members ONLY.
Emergency and Urgent Care Services
PRC for a currently enrolled Osage member who resides in the defined catchment area and needs emergent or urgent care.
- Notify PRC on the next business day or within 72 hours after your ER visit. Notification does not assure authorization of payment. However, if you do not notify PRC within 72 hours, your bills will not be paid. PLEASE CALL 918.287.9388 TO REPORT YOUR ER VISIT.
- For Osage members without insurance, evidence must exist that your visit was medically necessary. Medical priorities have been established to determine which referrals can be authorized for payment.
- For Osage members with insurance, evidence must exist that a third-party resource has determined that such services were “emergency care” or “urgent care.” Such evidence may include payment from private insurance.
- If you receive a bill from a provider, please provide a copy to PRC. You may leave bills at the Whazhazhe Health Center PRC office.
Purchased Referred Care for Osage Members with Insurance
PRC for a currently enrolled Osage member who resides in the defined catchment area and has Medicare or private insurance.
- To complete existing PRC patient updates, please visit Patient Registration at the Whazhazhe Health Center during regular hours of operation. For new Osage tribal members to become established for PRC services, please make an appointment to see the New Patient Coordinator/PBA at the Whazhazhe Health Center during regular hours of operation.
- Notify PRC at least 48 hours before the appointment date for a Coordination of Benefits (COB) to be sent to the provider.
- Inform the provider/health facility that Osage Nation Health System PRC is a secondary payer/payer of last resort.
- If you receive a bill from a provider, please provide a copy to PRC. You may leave bills at the Whazhazhe Health Center PRC office.
Purchased Referred Care for Osage members without Insurance
PRC for a currently enrolled as an Osage member who resides in the defined catchment area and does not have insurance.
- You must apply for all available resources, such as Medicaid, Medicare, Worker’s Compensation, Vocational Rehabilitation, auto insurance, and other personal injury or liability coverage. PRC staff and Patient Benefit Advocates can assist you with the application process for alternate resources. Failure to exhaust available or potentially available alternate resources may result in denial of payment.
- To complete existing PRC patient updates, please visit Patient Registration at the Whazhazhe Health Center during regular hours of operation. For new Osage tribal members to become established for PRC services, please make an appointment to see the New Patient Coordinator/PBA at either the Whazhazhe Health Center.
- You must utilize the services provided at the Whazhazhe Health Center before being referred out.
- Referrals for outside services must be sent to the PRC. Services must be medically approved by an Osage Health provider and CMMR Committee.
- An appointment will be scheduled, and a COB will be sent to the outside provider.
- If you receive a bill from a provider, please provide a copy to PRC. You may leave bills at the Whazhazhe Health Center.
Other frequently asked questions and information can be found here: See pages 17-18 of our patient handbook.
