PRC CHS

Purchased Referred Care and Contract Health Service

The PRC/CHS (Purchase Referred Care/Contract Health Services) Program is for medical/dental/behavioral care provided to eligible tribal members. PRC/CHS is not an entitlement program. If IHS is requested to pay, the patient must meet the residency requirements, notification requirements, insurance verification requirements, updated paperwork requirements, medical priority, and use of alternate resources.

Tribal Members are required to update a PAO-21 yearly to stay PRC/CHS eligible. Along with updated paperwork, you need to provide a valid Tribal ID and active health insurance. Verification of eligibility of payment for services is required prior to appointment. Failure to do so could result in services not being paid for.

If you have any questions regarding your eligibility or would like to request support from this program, you can call the PRC CHS Coordinator at (360)452-6252 extension 7613.

For more information visit the Indian Health Services website:

External link to IHS.gov

Notice of Summer Medical Travel Program Funds

This letter is to notify the Lower Elwha Tribal Community who utilize the PRC/CHS Travel Program that the summer tourist season is upon us. It happens earlier and earlier each year. We have been notified by the hotels that we utilize in the greater Seattle metro, and Silverdale/Bremerton areas that beginning April 1, 2025, these businesses will be implementing the first stages of “summer rate” changes, meaning the rates for popular tourist areas are expected to raise 3 to 4 times higher during this time and will range from $400-$750 per night. Hotels in these areas are booked well in advanced and fill up fast. We will do our best but cannot guarantee accommodations for an overnight stay.

I have attached the current Medical Travel Policy for reference of the overnight accommodations.

  • Hotels will be provided for emergency travel up to 4 days at a time, with a maximum of 30 days.
  • Tribal elders will be provided a hotel if the appointment check in time is before 10:00 am.
  • Tribal members with children under 2 will be provided hotel if the appointment check in time is before 9:30 am.
  • All other age groups will be provided hotel if the appointment check in time is before 9 am.
  • A note is required for hotel stays from a Lower Elwha provider if none of the above criteria is met.

**Please note that all travel is subject to availability and funds. A Travel Form with proof of appointment is required to be submitted 10 business days prior to travel. **

We appreciate your understanding and cooperation during this time. If you have any questions please reach out to PRC Coordinator at 360-452-6252 Ext 7613 or work phone 360-797-3156.

Frequently Asked Medical Travel Questions

Who is eligible for medical travel:

Lower Elwha Klallam Tribal members who are PRC/CHS eligible.

What is medical travel:

Medical travel for PRC is funds used to assist tribal members who have appointments outside of Clallam County. This program pays for a per diem stipend of $50 per day, per tribal member. Hotel stay if applicable, fuel of $50(Bremerton), $75 King County and ferry passes.

What are the requirements:

PRC is the payer of last resort; tribal members who have Medicaid will need to utilize those services first for Fuel and Ferry. You will be required to submit a travel form (available at the clinic) with proof of appt outside Clallam County.

FAQ:

  • Travel forms must be submitted 10 business day before travel (this gives accounting time to process checks)
  • In house items include( ferry passes and fuel vouchers)
  • Forms turned in will be processed in accordance with the policies, you will be called if more information is needed.
  • The policies for medical travel can be found on the front page of the travel form.
  • All efforts are made to get thing processed quickly, turning things in before travel helps us insure that we can help you with your travel needs.
  • Upon return of travel all receipts must be turned in or you will be denied for future medical travel assistance.
  • If you lose a receipt we have a lost receipt form that must be submitted.
  • We only pay for patient and driver (in cases) for perdiem.
  • Hotels are only authorized for appts that require you to be there before 9 am. Elders that time is 10am.
  • Summer time is hard to get hotels as we are a tourist spot on the northwest. We ask that you make all regular appointments for later times during the summer months as we cannot guarantee a hotel room for you.
  • If you have Medicaid insurance you will need to submit your driver license, car insurance and car registration to Fueldocs@paratransit.net and call 1-800-756-5438 to set up account and get fuel card and ferry card
  • We will always help with travel until you get set up with paratransit, and in case that paratransit denies services, with denial in writing.

If you have any further questions, please call the PRC Coordinator at 360-452-6252 Ext 7613 or

360-797-3156

Keep your info up to date. Print off and fill out the yearly PAO-21 here.

PAO-21-FinalDownload

Frequently Asked Questions for Contract health Services

  • Eligibility includes: Enrolled Lower Elwha Klallam Tribal members, First Generation Decedents, anyone enrolled in a federally recognized tribe (with proof of enrollment) and has lived on our reservation for 5 years consecutively (proof required).
  • In order to be eligible for Contract Health Services you must have Primary insurance, for medical, dental and vision.
  • Referrals: All referrals must come from Lower Elwha Health Clinic providers in order to pay bills outside your Indian Health Facility, this includes for: Primary care, Specialty, Message, Chiropractic, Mental Health, and Dental.
  • Vision: Purchase Referred Care is the payer of last resort in all cases. The PRC vision policy will provide supplemental support for vision expenses for our PRC eligible members. Tribal members 55 and over and eligible every 12 months for an eye exam and members under 55 are eligible every 24 months for an eye exam.
    • To be eligible for vision coverage you must:
      • Qualify for PRC
      • Must go to an optometrist who is contracted with your insurance plan
      • Must be current and compliant with diabetic quarterlies (if diabetic)
    • PRC will pay for :
      • Co-Payments and Co-Insurances on vision claims which are covered by your primary insurance.
      • Lenses annually
        • $99.00 for single vison lenses
        • $148.00 for bifocal lenses
        • $179.00 for trifocal lenses
        • $145.00 for contact lenses
      • Frames every 24 months for under 55 years of age. PRC will cover frames for patients 55 years of age and older annually.
      • PRC will pay up to the amounts above after insurance have been utilized. The services below are NOT COVERED unless they are considered medically necessary with a note from the optometrist:
        • Tint
        • Anti-Reflective Coating
        • Transitional Lenses
        • Progressive Lenses
        • High Index Lenses
        • Poly Carbonate Lenses
  • Medical Emergency: If you are experiencing a non-life-threatening medical emergency, you must access the after-hour nursing line at 541-529-9256 and get triaged before accessing emergency room services. If the nursing lines recommends the emergency room, it is your responsibility to call and notify CHS Coordinator at 360-452-6252 Ext 7613 within 72 hours of accessing emergency room in order for claims to be paid, failure to notify will result in denied claims.
  • Walk in Clinic: Walk-in Clinic may be accessed with approval of CHS Coordinator, to ensure no same day appointment are available at your Indian Health Facility, Lower Elwha Health Clinic. Failure to get approval will result in denied claims.
  • Massage and Chiropractic: Massage and Chiropractic are offered to all CHS eligible tribal members with referral from Lower Elwha Health Clinic provider, 12 visits per year for Message and 12 visits per year for Chiropractic.
  • Prescriptions: Prescriptions need approval to be reimbursed. All CHS eligible tribal members should have a True Scripts card to be used as a Secondary payer for prescriptions. If it is a new prescription, your insurance and/or True Scripts may require a prior authorization. This can take up to three days. If you have complications with your True Scripts card, call the customer service number on the back of the card. If you do not have a True Scripts card, call the PRC/CHS Coordinator at 360-452-6252 ext. 7613 and request a card.