Purchased / Referred Care (PRC)

Work with SEARHC to approve outside care

• Authorization is required before non-emergency treatment can be started.
• A SEARHC physician must initiate all referrals for medical care.
• A referral does not mean payment will be authorized. Outside care must be approved by PRC.
• For SEARHC to cover the cost of outside emergency medical care, PRC must be notified within 72 hours of the start of emergency services (65 years and older have 30 days to notify).
• IHS facilities must be used instead of private facilities, if available. Click this link for locations of tribal clinics or hospitals by location.

Who qualifies for PRC coverage?

To qualify for PRC services, the patient must meet PRC eligibility requirements that include, but are not limited to, the following:

• Documented status as Alaska Native/American Indian.
• Alaska resident for the prior 180 days with intent to remain in Alaska.
• Non-Indian women who are pregnant with an eligible, Alaska Native/American Indian child or the mother of an Alaska Native/American Indian child up to six weeks postpartum.
• Children of an eligible, Alaska Native/American Indian, including non-Indian foster children, adopted children, stepchildren, legal wards or orphans until the age of 19.

The following services may not be approved:

• Medical services provided by a non-tribal facility or provider not authorized by SEARHC PRC.
• Medical services provided by a non-SEARHC healthcare provider not referred by a SEARHC physician and authorized by SEARHC PRC.
• Obstetric deliveries at non-tribal hospitals, unless due to a life-threatening emergency.
• Inpatient or outpatient mental health services.
• Inpatient or outpatient substance abuse treatment programs.
• Medical care considered investigational or experimental.
• Nursing home or long-term care facilities.
• Routine dental services.
• PRC will not authorize payment to a non-tribal facility if a tribal health facility was open and available to provide the needed care.

This is not an all-inclusive list. Please contact PRC at prcservices@searhc.org about coverage if you have any questions.

Traveling outside of the SEARHC service area?

Patients have 30 days from date of service to submit bills or statements for services provided.

• While traveling outside the SEARHC service area or outside Alaska for a personal trip or vacation and you or your PRC eligible family members receive emergency medical services, you are required to contact SEARHC Purchase/Referred Care (PRC) within 72 hours. Patients 65+ have 30 days to notify PRC.
• Notifying PRC is required by Indian Health Services (IHS) to determine if the services received are eligible to be paid for by SEARHC PRC. Also, notifying PRC timely will assist in preventing you from receiving bills or being sent to collections for non-payment.
• If you have received a bill for emergency services while outside the SEARHC service area or Alaska, please submit your bills via fax or email using the SEARHC PRC contact information below.
• Indian Health Services policy does state that patients have 30 days from date of service to submit bills or statements for services provided.

Before you go to school…

Students must take care of routine medical and dental needs before leaving Alaska. Routine care includes school physicals, immunizations, vision examinations, birth control, dental care, etc.