The Contract Care Department is responsible for payment of outside services for eligible consortium and non-consortium members and their families. To become eligible for Contract Care benefits a person must be enrolled through a federally recognized tribe, reside in Riverside or San Bernardino County and have close social and economical ties with a consortium tribe. If the member is a fulltime student, and he or she temporarily resides outside Riverside or San Bernardino County, their Contract Care eligibility status will remain active. A member can be part of a non-consortium federally recognized tribe and receive contract health care benefits based on his or her lineal descent, and their place of residency, which must be on one of our consortium reservations. A Non-Indian carrying an eligible Indian child or an eligible Indian being treated for a communicable disease may qualify for Contract Care benefits as well. In order to receive these benefits from Contract Care funds, the patient must be screened for alternate healthcare coverage, for example: Medi-Cal, Medicare, MISP, MIA, to help assist with payment of their outstanding bills. The Contract Care Program is the payer of last resort. All outside services must be authorized, reviewed, and approved by our clinic providers and the Utilization Review committee. If emergency services are required, the patient should contact our on-call physician/counselor to discuss their health care need. If the patient is unable to contact the on-call physician/counselor, and the situation requires immediate care they should have a family member, outside facility/agency representing the patient notify the Contract Care or Utilization Review staff the next day, or within 72 hours after the emergency. Our elders and disabled tribal members have 30 days to notify RSBCIHI after the emergency services. It is recommended that when calling the on-call physician or counselor, the patient should note the date, time and the provider/counselor’s name they spoke with when the emergency occurred. Failure to comply with this process can result in a denial of Contract Care benefits.
If the patient receives bills/statements or letters for services performed for outside services at their home/mailing address, they should contact the Contract Care Department immediately. A person can walk in, fax it or mail it into the Contract Care claims office. Remember, the sooner the Contract Care office is notified, the sooner the staff can respond to a person’s questions regarding their outstanding bills.If the patient has health insurance and they process their claim; the Explanation of Benefits they will receive from their insurance company should be sent to the Contract Care office for review. We may be able to assist you with payment for any balances listed on the explanation of benefits. If applying for alternate health care coverage a person must comply with the application process by following through with the application and providing all required documents. Failure to do so could result in the Contract Care office denying financial assistance.
Please remember, all services must be approved, authorized, and reviewed by our Utilization Review Committee, our Clinical Providers and the Utilization Staff before Contract Care can consider payment of outside bills. Contract Care is the payer of last resort and has limited funds for services that are medically indicated which are not provided by RSBCIHI, Inc or reasonably accessible. This fund is governed by federal regulations contained in 42.C.F.R. Section 36.23, effective August 4, 1978.
Consortium tribal member should use our Pharmacy whenever possible. However should he/she have to use an outside Pharmacy they need to bring their receipt for review to the Contract Care Department immediately! Durable medical equipment, cosmetic, and experimental procedures are not covered as RSBIHI Contract Care benefits.