Purchased/Referred Care
Helping eligible Tribal members access medical care and essential health services not directly available at St. Croix Tribal clinics.
Your Connection to Additional Medical Care
Purchased/Referred Care (PRC) is designed to help St. Croix Tribal members receive healthcare services that cannot be provided locally. PRC works with approved providers to cover necessary care—from specialty appointments to urgent treatments—ensuring members receive the right services at the right time.
Eligibility
PRC is available to enrolled Tribal members who meet residency, income, and medical necessity guidelines. Services must be pre-approved and referred by an eligible provider.
Covered Services
PRC may assist with costs for referred medical appointments, specialty care, certain diagnostic tests, and other approved treatments not offered by Tribal facilities.
Service Staff
Meet the dedicated individuals serving our community.
Eligibility
Eligibility is determined through:
- IHS Rules, Regulations, and Policies listed in the Federal Register 42 CFR Parts 36 and 36A
- IHS Purchased/Referred Care Manual Procedures
- Individual Tribal Policy and Procedures
Verified by Purchased/Referred Care (PRC) PRIOR to referral out and authorization for payment is granted with a purchase order to be presented at outside agency patient registration.
Purchase Order System
- Patient has been determined eligible for Purchased/Referred Care Services.
- Verification from provider referring patient to an outside agency for services.
- Appointment date and time is set by provider after speaking with PRC.
- Purchase Order is issued to patient to take to the appointment with them or can be faxed/emailed prior to appointment.
- Patient must present purchase order upon registration for appointment at outside agency they are advised to bring proof of other insurance with them as well.
- Outside Agency patient registration screens for additional health care coverage.
- Outside Agency patient registration presents purchase order to outside agency billing department for processing.
- Outside agency billing department bills all other insurances and then sends the UB92 or HCFA Forms with the purchase order to the Purchased/Referred Care Office for payment.
Please note: Per IHS, PRC is a payor-of-last-resort. All other resources must be utilized first.
- Upon receipt of invoice or bill please turn into PRC, however if you followed the purchase order system the outside agency would have submitted the bill to PRC rather than to you. If the patient did not follow the purchase order system, payment can be denied and the patient will have complete liability.
- Total processing time from when Purchased/Referred Care receives a claim with the purchase order
approximately 1-3 weeks.
FAQS
Find answers to common questions about our services and operations below.
Still have questions?
We're here to help you with any inquiries.
Get in Touch
General contact information for the St. Croix Chippewa Indians of Wisconsin is listed below. For specific department information, view our directory.
Phone
Main Office
