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Purchased/Referred Care (PRC) funding and procedures
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Governs ANTHC Purchased/Referred Care processes for funding referred medical services not available at ANMC and responsibilities of patients, including alternate resource application, notification requirements for out-of-facility emergency care, and coverage limits.
No material clinical or coverage changes in this revision.
Key Definitions
PRC Coverage Requirements and Limitations
PRC coverage requirements and limitations
PRC funding is conditional and limited. PRC acts as the payer of last resort and will only consider payment when specific requirements are met; certain services are excluded from PRC funding.
Provider Responsibilities and Notification
Referral and Travel Authorization Requirements
Referrals and travel authorizations initiated by ANMC providers do not guarantee payment. When an ANMC provider initiates a referral, ANTHC PRC coordinates authorized travel (airfare and lodging) for the patient and any medically necessary escort. Escorts must be authorized as medically necessary. Referrals may be made for services not available at ANMC, but a referral is not a guarantee of payment by ANTHC PRC. Patients need a referral from an ANMC provider for every visit outside of the Tribal health system, including follow-up visits. PRC operates multiple programs across Alaska (including Traveler and Student programs) that may provide funding for residents in their respective service areas; coverage for services outside Alaska varies by program.
- Referrals do not guarantee payment.
- Patients need a referral from an ANMC provider for every visit outside the Tribal health system (including follow-ups).
- When authorized, ANTHC PRC coordinates airfare and lodging for patient and approved escorts; escorts must be authorized as medically necessary.
- PRC funding and programs vary by region; referrals may be made for services not available at ANMC.
Emergency Notification
All emergent medical services received outside of ANMC must be reported to PRC within 72 hours by calling 1-800-478-1636. Leave a voice message if calling on holidays, weekends, or after normal business hours. Notification of an emergency does not guarantee payment.
- Report emergent medical services received outside ANMC within 72 hours.
- Call 1-800-478-1636 — leave a voice message if after hours or on weekends/holidays.
- Notification does not guarantee payment.
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