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U.S. Department of Health and Human Services
Phoenix Area

Purchased and Referred Care (PRC)

PRC'

The Purchased and Referred Care (PRC) Program is integral to providing comprehensive health care services to American Indians and Alaska Natives (AI/AN). The general purpose of PRC is for IHS and tribal facilities to purchase services from private health care providers in situations where: 1) no IHS or tribal direct care facility exists; 2) the existing direct care element is incapable of providing required emergency and/or specialty care; 3) utilization in the direct care element exceeds existing staffing; and 4) supplementation of alternate resources (e.g., Medicare, Medicaid, or private insurance) is required to provide comprehensive health care to eligible AI/AN.

PRC'

Eligibility Requirements

To be eligible to receive purchased and referred care from an alternate healthcare facility, the following must apply.

  1. Indian Descent: To be PRC eligible at a federal facility, the patient must be a member of a tribe served by the local PRC delivery area.

  2. Residency: Residency means that a person must be an enrolled member or descendant of a tribe within the PIMC Purchased Referred Care Delivery Area (PRCDA), and must reside within Maricopa County. If any member relocates out of their service area, they will remain PRC eligible for up to 180 days.

    Other tribal members not from Maricopa County must have social economic ties to a tribe within Maricopa County to be considered PRC eligible.

    Social/Economic means you reside on, you work for, or are married to a member of a tribe listed below

  3. Medical Priority: Not all services are covered by PRC. Occasionally, health care professionals refer patients for specialties and services that are important, but are not necessarily covered by service under the IHS medical priorities. Going to a non-IHS hospital emergency department on your own for something that is not an emergency does not meet medical priority.

  4. Notification/Prior-Authorization: In case of Emergencies, the patient, or someone acting on their behalf must notify PRC within 72 hours if the patient is seen at a non-IHS facility emergency department. For Non-Emergencies, The patient and/or guardian needs to get prior authorization from PIMC PRC for scheduled appointments outside of PIMC. Elderly and disable patients (65+) have 30 days to notify PRC.

    All referrals for outside services, follow ups, treatments must first be initiated by a provider at PIMC.

  5. Alternate Resources Available: PRC is the last resort payer by federal regulation. There is a potential you may be eligible for Medicaid, please see a Benefits Coordinator. You must apply for these resources before PRC funds will be considered.

Tribes Covered Under PIMC PRCDA

PRC'

  • Gila River Indian Community (must reside in Maricopa County. Members living in Pinal Country are PRC through GRIC PRC)
  • Tohono O'odham Nation (must reside in Maricopa County. Members living in Pinal Country are PRC through Sells Indian Hospital)
  • Fort McDowell Apache (members living on the reservation are PRC eligible through Wassaja Health Center. Members living off the reservation are PRC through PIMC) (Maricopa County)
  • Yavapai Apache Nation (Members must reside on Reservation or remain in Yavapai County)
  • Yavapai Prescott (Members must reside on Reservation or remain in Yavapai County)
  • Tonto Apache Payson (Members must reside on Reservation or remain in Gila County)

Important Things to Remember

It is important for you to find out from PRC who will be responsible to pay for your medical bills before you get health care outside of PIMC. If you do not get PRC approval before you go outside of PIMC, you may be financially responsible.

PRC is only available to eligible patients as long as funds are available (42 CFR 136.23).

If you’re unsure about your eligibility, call us today.

Your Responsibility

It is your responsibility to register with the Phoenix Indian Medical Center (PIMC). When you register, your eligibility for “direct” care is determined.

When you register, you will need to show proof of your Indian descent and you will be asked to verify where you live.

What if Funding is Denied?

If payment is denied, a letter will be sent to you by the PRC Department. This denial letter gives the reason(s) for denial and explains your rights to appeal the decision.

You have 30 days from the receipt of the denial letter to appeal at the local level (PIMC/PRC). If you have additional information that was not already provided to the PRC Department, you may submit it with your appeal.

You will receive a response to your first level of appeal in writing from PIMC/PRC and if you are not satisfied with that response you will have 30 days from the date of the letter to file another appeal.

If you are not satisfied with the response from PIMC, you may send a letter of appeal to the second level at the Phoenix Area Director within 30 days of receiving the local level decision.

Your final appeal may be made to the Director, IHS, and their decision constitutes the final administrative action of the IHS.

Appeal letters can be submitted to the following address:

Phoenix Indian Medical Center
Attn: Chief Executive Officer
4212 N. 16th Street
Phoenix, Arizona, 85016

IHS Medical and Dental Priority Levels

PIMC determines the amount and duration of services that may be purchased based on available resources and Indian Health Service Medical and Dental Priority Levels.

The PRC Medical and Dental Priority Levels are available to view here.

Business Hours

M-F: 8:00AM - 4:30PM

Contact Information

Phone: 602-263-1569
Fax: 602-263-1589
Email us at pimcprc@ihs.gov but please don’t include any personal health information.