​Who is prc eligible?

• Enrolled member of a federally recognized tribe or descendant of a federally recognized tribe.
• Live on or near the Pyramid Lake Reservation
• If you are a full-time student out of state (you must have PRC student form filled out by college/school). Forms are available at PLHC.
• Must apply for all alternative resources including but not limited to: NV Medicaid, NV Check-up, Medicare, Disability.
• Any child under 19 who is natural, adopted, stepchild through marriage, foster child, legal ward or orphan of an eligible Indian.
• A non-native woman pregnant with an eligible Indian child. An affidavit must be signed to be seen as a direct patient.

referral process:

• A provider from the PLTHC will create a referral.
  
• The PRC clerk will verify insurance. If you do not have any insurance, you will be referred to a Health Benefits Representative. Health Benefits will assist you with applying for Alternate Resources.
• The PRC Clerk will forward your referral to Indian Health Service (IHS) for authorization.
• Once resources are verified and authorization has been given (approval or denial), the PRC clerk will fax to the appropriate specialty/facility.
• Once the referrals are faxed and scheduled, PRC will mail them, or patient may pick up Referral.

patient responsibilities are:

1. Obtain initial Referral from PLTHC providers.
2. Ensure that all contacts and insurance information is correct upon checking in at PLTHC. (All updated information determines PRC services).
3. Applying for any/all alternate resources; if eligible.
4. Notify PRC clerks of all scheduling, rescheduling and cancellation of outside appointments!
5. Arranging Transportation. If clinic is transporting, please contact Transportation 24 hours prior to appointment with date, time & address of facility.
6. Report emergency room visits withing a 72 hour (3 days) to PRC department for elderly persons, and 30 days from the time of service for physically/mentally disabled persons.

approval/denial:

• All referrals are forward to Schurz Service Unit (SSU) for review & authorization.
• Must obtain new referrals every year on October 1st for ongoing services.
• Medical priority levels are determined by SSU/PRC committee.

*Note: PLTHC or PRC clerks do not determine approval and/or denials for PRC funds.*

Appeals process:

If you have been denied & are not satisfied with the decision, you must:

1. Receive a certified letter from IHS.
2. You will have 30 days to respond to CEO or Area Director IHS/Phoenix.
3. In your appeal letter, please write a statement as to why this medical/dental referral is needed & why you feel IHS should be paying for it.
4. Request all records pertinent to medical condition(s). A letter from your primary & specialty providers would be helpful.
5. You may also request assistance from the Purchased Referred Care (PRC) clerks here at the Pyramid Lake Tribal Health Clinic (PLTHC).

Indian Health Service
SSU/PRC
1150 Financial Blvd STE 500
​Reno, NV 89502

alternate resources:

Alternate resources are all other sources of health care or health care payment that are available and accessible to an individual.

Examples of alternate resources include, but are not limited to: Medicare, Medicaid, Veterans Benefits, Champ, Private Health Insurance, Workman's Compensation, or State Vocational Rehabilitation.

Plthc prc clerks |

Athena Lamebull (A-M), EXT 1219

Collette Auguh (N-Z), EXT 1253