Primary Care
All non-IHS primary care services must be prior-authorized before obtaining services. If you live within 25 miles of an IHS (Indian Health Service/Tribal/Urban-ITU) facility, you must first use this resource for your primary care services.
Specialty Care
Patient must be referred to a specialist from an IHS provider due to medical necessity. The patient may not self-refer to a specialist.
A written referral or any other pertinent information is required and must be submitted to PRC prior to scheduling an appointment. The information will be reviewed and a decision made as to acceptance or denial of specialty services.
Vision Services
DENTAL SERVICES
EMERGENCY SERVICES
In emergency cases, a sick or disabled member, or an individual or agency acting on behalf of the member shall within 72 hours after the beginning of treatment notify PRC of the service and submit information necessary to determine the relative medical need for the services and eligibility of the individual for the services.
Section 406 of P.L., allows the elderly and disabled 30 days to notify PRC of the emergency medical care received. Any medical condition for which immediate medical attention is necessary to prevent the death or serious impairment of the health of an individual.
Definition of an emergency – Any medical condition for which immediate medical attention is necessary to prevent the death or serious impairment of the health of an individual.
Other Funding Sources
All alternate resources must be exhausted. Please contact the following State programs for potential coverage.
Nebraska
Nebraska Health and Human Services
Office of Women’s and Men’s Health
Every Women Matters Program
Nebraska Colon Cancer Program 800-532-2227
dhhs.ne.gov/womenshealth
dhhs.ne.gov/menshealth
dhhs.ne.gov/crc
Iowa
Iowa Health and Human Services
Breast and Cervical Cancer Early Detection/WISEWOMAN
Iowa Department of Public Health
800-369-2229
www.womenshealthiowa.info
South Dakota
South Dakota Department of Social Services
South Dakota Department of Health
WISEWOMAN Program
605-733-3622 or 800-738-2301
getscreened.sd.gov
PRC is a payer of last resort. When a patient has Medicare, Medicaid, Veteran’s benefits, private insurance, worker’s compensation, or is covered by any other resource, that resource is the primary carrier. Patients must immediately provide all explanations of benefits from the primary carrier(s) to the PRC office when received by the patient.