Welcome to the Managed Care Department at Choctaw Health Center. Our comprehensive services are designed to support our community's health and well-being. We offer a range of specialized departments, including
Advance Health-Care Directives
Learn more about advance directives, a written statement of a person's wishes regarding medical treatment.
Case Management
Our dedicated case managers work closely with patients to coordinate care, ensuring that individuals receive the appropriate services tailored to their needs.
Hospital Meal Program
Learn more about the hospital meal program, a service that provides meals to patients and families.
Purchased & Referred Care (PRC)
This department is responsible for managing purchased services, providing patients with options for high-quality care within our network.
Referral Department
Our Referral Department facilitates seamless communication with external healthcare providers, ensuring timely access to specialized services for our patients.
Social Workers
Our skilled social workers are available to assist patients with various social and emotional needs, offering support and resources to enhance overall health.
At Choctaw Health Center, we are committed to providing comprehensive, patient-centered care that helps our community thrive. For more information about our Managed Care Department and the services we offer, please contact us today!
Purchased & Referred Care (PRC)
Purchased & Referred Care is a program that helps eligible American Indian patients get the necessary special health care service needed that is not available at Choctaw Health Center.
FAQs
1. I thought Purchased & Referred Care was my IHS insurance and covered my medical expenses whenever I left the reservation?
Purchased & Referred Care is NOT an IHS insurance program.
2. What about U.S. Treaty obligations? Does this include health coverage?
IHS does not cover payment for all medical services a patient wants or receives. They provide primary (direct) care (at no cost) at the IHS facility. Through Purchased & Referred Care, the IHS covers only certain necessary services.
3. Why does PRC have so many requirements?
Purchased & Referred Care funds are limited. The Native American community are increasing in number which means we have more people who require special health care services that are not available at Choctaw Health Center. These laws make sure all patients receive consistent and fair treatment.
4. If I meet four of the five eligibility criteria, will you let me slide?
No. Each individual requesting for PRC assistance must meet all five eligibility criteria.
5. Why do I have to apply for medical insurance to be eligible for Purchased & Referred Care?
If you are eligible for some type of medical insurance and use it, then Purchased & Referred Care will have more funds to help more patients for a longer time.
6. What if I don't qualify for Purchased & Referred Care, how do I pay my medical bills?
The Purchased & Referred Care staff will refer you to a Patient Benefits Specialist to apply for Mississippi Medicaid program, medicare, or any other program that you may be eligible for.
Eligibility Criteria
There are five eligibility requirements that the patient must meet
1. Indian Decent
The patient must be a member of the Mississippi Band of Choctaw Indians. You must be a Native American with a verified tribal census number or Certificate of Indian Blood (CDIB).
Exception:
A non-indian woman who is pregnant with an eligible Indian child is eligible for care during pregnancy and six weeks postpartum.
2. Residency
The patient must live within the Mississippi 50 mile radius.
3. Medical Priority
You must be receiving care for a condition that meets the Choctaw Health center Medical Priority and Necessity guidelines. Only life-threatening and limb threatening situations are emergencies.
If you go to a non-IHS hospital Emergency Room for something that is not an emergency (like a cold) this will not meet medical priority.
4. Alternate Resources
Purchased & Referred Care is considered Payor of Last Resort and secondary to all alternate health resources, i.e., Medicare, Medicaid, private insurance, etc.
You must apply for and use any other alternate health care resources available to you before Purchased & Referred Care funds can assist with the payment of any Non-IHS provider/facility health care bills. This includes: Medicare, State Medicaid or private insurance.
5. Notification / Prior Authorization
Purchased & Referred Care must be properly notified when a patient has or will be obtaining medical services from a non-MS provider/facility:
Notification occurs after the emergency service
- Emergent - PRC must be notified within 72 hours from the time the patient received treatment or was admitted. For an elderly & disabled person(s), the notification timeline is within 30 business days.
Prior Authorization occurs before service is provided.
- Non-emergent - The patient must obtain prior authorization (approval) from Purchased & Referred Care for all appointments scheduled by a non-Choctaw Health Center physician before getting treated.
- If the nearest health care facility is an IHS facility, but you choose to go to a Non-IHS facility, Purchased & Referred Care will not pay for your emergency care.
How Purchased & Referred Care Determines Payments
Purchased & Referred Care makes their decisions to approve or deny payment based on Medical Priority, Eligibility, and Availability of Funds.
Purchased & Referred Care Authorization Diagram Process
The patient must be a member of MBCI.
You must be a Native American with a verified tribal census number or Certificate of Indian Blood (CDIB)
Exception: A non-Indian woman who is pregnant with an eligible Indian's child. Eligible for care during pregnancy and six weeks postpartum.
Learn More About Managed Care
Advance Health-Care Directives
Learn more about advance directives, a written statement of a person's wishes regarding medical treatment.
Case Management
Our dedicated case managers work closely with patients to coordinate care, ensuring that individuals receive the appropriate services tailored to their needs.
Hospital Meal Program
Learn more about the hospital meal program, a service that provides meals to patients and families.
Purchased & Referred Care (PRC)
This department is responsible for managing purchased services, providing patients with options for high-quality care within our network.
Referral Department
Our Referral Department facilitates seamless communication with external healthcare providers, ensuring timely access to specialized services for our patients.
Social Workers
Our skilled social workers are available to assist patients with various social and emotional needs, offering support and resources to enhance overall health.