What is PRC?
Purchased / Referred Care is a program that acts as a payer of last resort, helping to fund medical services provided by outside specialists and hospitals. This includes a variety of care types such as specialty referrals, emergency room visits, hospitalizations, and other services not offered on-site.
Eligibility for PRC
To be considered for PRC assistance, you must:
- Be an enrolled member of a federally recognized tribe.
- Reside within the Bad River Health and Wellness Center's designated service area.
- Have a medical need for a service that is not available at our facility.
- Complete an application and meet all required documentation criteria.
- Exhaust all other payment options, including private insurance, Medicare, or Medicaid. PRC is a payer of last resort.
How to Access PRC Services
- Get a Referral: All services must be initiated with a referral from a Bad River Health and Wellness Center provider. This ensures your care is medically necessary and properly documented.
- Contact the PRC Department: Our dedicated PRC team will help you complete the necessary paperwork and guide you through the process.
- Prior Approval is Required: For most services, prior approval from the PRC department is required before you receive care from an outside provider. This step is critical to ensure payment for services.
Important Considerations
- Medical Necessity: All services covered by PRC must be medically necessary as determined by a Bad River Health and Wellness Center provider.
- Payer of Last Resort: You must first use any other available insurance or benefits (such as private insurance, Medicare, or Medicaid) before PRC funds can be used.
- Timeliness: It is essential to seek approval from our PRC department as soon as possible after a referral to an outside provider is made.
- Documentation: Be prepared to provide all necessary documentation, including tribal enrollment and residency verification, to determine eligibility.
