Purchased Referred Care

Riverside San Bernardino County Indian Health, Inc.

The Purchased/Referred Care (PRC) Department is responsible for payment of outside services for eligible consortium and non-consortium members and their families. To become eligible for Contract Care bene-fits 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 PRC 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 PRC benefits as well. In order to receive these benefits from PRC funds, the patient must be screened for alternate healthcare coverage, for example:

The Senior Nutrition Program provides nutrition services to Seniors who reside either on the Pechanga, Morongo, Cahuilla, Santa Rosa, Torres-Martinez or Soboba Indian Reservations or in adjacent communities. The general nature of this project is to provide elders 60 years of age or older, their spouses, individuals with disabilities less than 60 years of age, who reside at home with that senior, a nutritious hot lunch, in an atmosphere which promotes good health, social recreation and nutrition education/counseling.

Our Senior Nutrition also features: Fit after 50 Exercise program for Seniors; Education and Support for Caregivers of Seniors; Senior Bingo Days; Senior Movie Days; Journey to Nutritious Shopping Days and Powerful tools for Caregivers Training. Should you directly receive payment from your insurance carrier for services provided by and paid for by RSBCIHI, such payment is to be submitted to RSBCIHI upon receipt. Otherwise, you will be subject to reimbursement to RSBCIHI for the amount of the payment.

If the patient receives bills/statements or letters for services performed for outside services at their home/mailing address, they should contact the PRC Department immediately. A person can walk in, fax it or mail it into the PRC claims office. Remember, the sooner the PRC office is notified, the sooner the staff can respond to a per-son’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 PRC 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 PRC 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 PRC can consider payment of outside bills. PRC 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 PRC Department immediately. Durable medical equipment, cosmetic, and experimental procedures are not covered as RSBCIHI PRC benefits.

Meet Our Staff

Keith Ford

PRC Coordinator

Morongo Clinic

Pamela Hengler

Claims Clerk

Morongo

Debbie Starr

Claims Examiner

Morongo