The Tribal Health Paid Care (THPC) program (formerly known as Contract Health Services, Purchased and Referred Care) are those funds used to purchase care not available at Tribal Health.

 

Eligibility

To be eligible for THPC benefits, a recipient must complete the necessary application to determine eligibility.  In addition to a completed application, recipients will be asked to provide proof of residency, select a primary care provider and provide proof of tribal affiliation.  The following are residency requirements:

  • Enrolled members of the Confederated Salish and Kootenai Tribes (CSKT) living on the Flathead Indian Reservation or in the service areas of Lake, Missoula, Sanders and Flathead counties.

 

  • Enrolled members of a federally recognized tribe living within the Flathead Indian Reservation.

 

  • Federally recognized tribal descendants living within the Flathead Indian Reservation.

 

  • Full-time students, who have previously met THPC eligibility requirements, carrying a minimum of 12 credits in college (undergraduate and graduate), vocational, technical or other academic institution during their attendance and established school breaks. Eligible for 180 days after completing course of study.

 

  • Acceptable forms for proof of residency must show a current physical address such as a current bill, lease, legal document, valid driver’s license, and/or a legal state ID.

 

 

Medical Preauthorization Request

All medical preauthorization request to specialists and/or for procedures must be requested through recipient’s Primary Care Provider. All medical referrals for service not performed at a Tribal Health facility must have prior authorization by THPC.  Call THPC prior to scheduling appointments to be certain the request is in order and has been authorized.

 

Patient Responsibilities

  • Emergency room and urgent care medical and dental visits must be reported to THPC within 72 hours. It is important to note Emergency Rooms are for true emergencies and will be reviewed by THPC to determine eligibility for payment.

 

  • Keep your information current with Tribal Health Patient Registration. Notify them of any change in address, phone number, emergency contact, new insurance, any changes to insurance, change in job, etc. Changes to Primary Care Provider must be reported prior to the initial visit with a new provider.

 

  • Be certain all Clinics, Providers, Hospitals, etc. have your insurance information and are aware you are covered by THPC.

 

  • If you receive a bill in the mail: Don't Throw It Away! Call the provider of the bill right away and ask if they billed your Insurance. THPC is the payer of last resort, meaning they pay the balance after insurance, Medicare, Medicaid, or any other coverage. After all others have paid, THPC covers the remainder for approved care.

 

Patient Accounts Representative (Alpha Split of Recipients Last Name)

  • Katie Tapia at ext. 5055 or This email address is being protected from spambots. You need JavaScript enabled to view it. ; Alpha Split A-F & V-Z
  • Richard Pierre at ext. 5117 or This email address is being protected from spambots. You need JavaScript enabled to view it.; Alpha Split G-K
  • Rhonda Hernandez at ext. 5061or This email address is being protected from spambots. You need JavaScript enabled to view it. ; Alpha Split L-O
  • Sarah Lutes at ext. 5043 or This email address is being protected from spambots. You need JavaScript enabled to view it. ; Alpha Split P-U

 

  • Teri Burke, RN - Medical Review RN at ext. 5044 or This email address is being protected from spambots. You need JavaScript enabled to view it.   
  • Clarice Cooper-Sandau, BSN, RN - Medical Review at ext. 5013 or This email address is being protected from spambots. You need JavaScript enabled to view it.
  • Rhonda Hendren, Paid Healthcare Division Manager at ext. 5029 or This email address is being protected from spambots. You need JavaScript enabled to view it.

 

How do I manage a medical bill incurred prior to December 1, 2016?

Questions regarding medical bills incurred prior to December 1, 2016, through Indian Health Service (IHS) Contract Health and/or Purchased and Referred Care (PRC), should be addressed directly with the Billings area IHS offices. IHS employees managed, and continue to manage, any PRC/Contract Health claims prior to December 1, 2016. Please contact IHS directly at: 

IHS Contact: Roberta Whiteman 

Phone: (406) 247-7202 

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

IHS Contact: Jolene Birdinground 

Phone: (406) 247-4067

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

APPLICATIONS AVAILABLE:

Tribal Health Paid Care Application
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