Contract Health Services
(605) 355 - 2419
IHS CONTRACT HEALTH SERVICES (CHS) IS NOT AN ENTITLEMENT PROGRAM AND NOT EVERYONE IS ELIGIBLE.
KNOW YOUR STATUS BEFORE OBTAINING SERVICES.
CHS Eligibility Requirements:
- Must be an Indian or descendant of an Indian from a Federally-Recognized Tribe or descendant of an Indian.
- Must be a permanent resident of Pennington County, South Dakota.
If you are eligible, IHS-CHS coverage is not automatic. Should you have an emergency situation requiring you to obtain care at a non-IHS facility, you must notify Contract Health Services within 72 hours. If you do not do this, you will be responsible for the bill.
IHS-CHS coverage is for emergent, life-threatening situations only! Sore throats, ear aches, rash, follow-up care, medicine bills, etc... are not considered emergent or life-threatening.
Emergency visits will not be covered if it would have been closer to go to an IHS
facility. If there is an IHS facility in the area and you choose not to use the facility, then you will be denied and held responsible for the bill.
Referral:
Medical care that is not available at the IHS facility. A REFERRAL IS NOT AN IMPLICATION THAT IHS WILL PAY FOR CARE. A patient must meet eligibility criteria, medical priorities, and use of alternate resources.
The referrals are reviewed and based on avalability of funds; the referral is then approved, denied or deferred. If a referral is denied, the patient may obtain medical care at their own expense.
IHS-CHS Authorization:
The Managed Care Committee will prioritize all referrals and call-in requests and make recommendations for approval or denial. The hospital Chief Executive Officer or their appointed designee is the only person who can approve and authorize
payment of services.
In most cases, an approved referral is limited to one medical treatment and.or one appointment. Please call Contract Health Services prior to any follow-up appointments, or referral to another specialist/facility for approval to make sure your coverage is still in effect.
Alternate Resource:
IHS-CHS is a payer of last resort. When a patient has Medicare, Medicaid Title 19, Private Insurance, Veteran's Assistance, CHAMPUS/TRICARE, Workman's Compensation,
or is covered by any other resource, that resource is the primary carrier/payor. All Explanations of Benefits (EOB) and payment checks from
the primary carrier/payor(s) must be brought or mailed to the CHS office without delay, when received by the patient. Many times the non-IHS will turn the patient's bill over to collections because they are unable to get the EOB from the patient. The
non-IHS provider cannot collect payment from IHS until they filed the bill with the EOB. Therefore, it is crucial for the patient to provide the EOB either to the non-IHS provider
or to the Contract Health Office in order to complete the payment process.
Pregnant/Prenatal Care:
For patients who are residents of Pennington County, CHS is requested to pay for the charges for your delivery/newborn care and hospitalization. According to Federal Register IHS Regulations, it is mandatory that all other resources
be utilized before CHS funds can be obligated. The South Dakota Department of Social Services has a program for which you may be eligible for Title 19 (Medicare 77 program). All pregnant women will be interviewed, advised and/or assisted by an IHS Patient Benefits Coordinator in applying for the Title 19
(Medicare 77 program). If you are denied, you will need to take the letter to the CHS office to be filed with your OB referral form. Failure to cooperate with IHS-CHS or the South Dakota Department of Social Services will result in denial to authorize payment for any charges you may incur.
|
