Purchased Referred Care

PRC Process

PRC-Process Handout

PRC-Student Form

PRC-Prior Authorization Form

PRC-Prior Authorization SNF LTC Form

Emergency Notification

Notification must be provided within 72 hours of discharge or admission by calling PRC direct at (928) 475-1298. If after hours, please leave a message with the following information:

1. Name/Date of Birth
2. Phone number
3. Date of emergency
4. Facility where you were seen
5. The reason or diagnosis
6. Mode of transportation

*Notification is not a guarantee of payment.

Alternate Resources

PRC is considered the “payor of last resort”. The use of alternate resources is required when such resources are available and accessible to the individual, such as

1. Medicare A and B
2. State Medicaid (AHCCCS/ALTCS)
3. State or other federal health programs
4. Private insurance, etc.
5. IHS or Tribal health facilities
6. Workman’s Comp

For assistance with applying for alternate resources, please contact your Patient Coordinators at (928) 475-1476 or (928) 475-1402.

Contact PRC

San Carlos Apache Healthcare Corporation
103 Medicine Way Road
Peridot, AZ 85542

PRC Direct (928) 475-1298

Main Telephone (928) 475-1400

Fax (928) 475-2284

Frequently Asked Questions

Question: Why are Indian descendants not eligible for CHS off the reservation?

Answer: Indian descendants residing off the reservation may be eligible if they meet certain conditions. If not residing on the reservation, such individuals must live within the CHSDA and (1) be members of the tribe(s) located on the associated reservations or (2) “maintain close economic and social ties with that tribe(s).”

Question: If a SCAHC doctor refers me to a specialist, why am I being held responsible for the bill?

Answer: Referrals are not a guarantee for payment. Referral is a recommendation for treatment/test only. The PRC committee must review the referral to make the determination for PRC approval of payment. All PRC eligibility requirements must also be met.

Question: Do I need a referral for every appointment scheduled with specialist outside SCAHC?

Answer: YES. If you are scheduled with a specialist that SCAHC providers’ referred you to, you are responsible for contacting PRC with appointment details. The referral will be presented to the PRC committee for approval. You should always pick up a referral before you go to your scheduled appointment to avoid denial of payment.