Purchased Referred Care
Important Facts That You Should Know About Contract Health
CHS Coverage is NOT AUTOMATIC. Should you have an emergency situation requiring you to obtain care at a non-IHS facility, you must notify the CHS office within 72 hours. If you do not do this you will be held responsible for the bill.
CHS Coverage is the Emergent, Life-threatening situations only. Sore Throats, earaches, medicine refills, etc., are not considered emergent or life threatening.
CHS will not cover a visit if it would have been closer to go to the nearest IHS facility. If there is an IHS facility in the area and you choose not to use this facility, you will be held responsible for the bill.
Non-compliance with approval process may serve as the basis for denial of payments. Contract Health Services is not an entitlement program and not everyone is eligible. Know your status before obtaining service.
Chippewa Cree Health Center medical staff providers write medical referrals when patients need medical care that is not available in an IHS facility. A REFERRAL IS NOT AN IMPLICATION THAT CARE WILL BE PAID. A patient must meet eligibility criteria, medical priorities and use of alternate resources. The referrals are reviewed daily and based on availability of funds, the referral is then approved, deferred or denied. If a referral is denied, the patient may elect to obtain medical service at their own expense.
Please do not request pre-authorization and pre-approval from the Rocky Boy Health Board. The CHS Committee must review all referrals and call-in requests.
The CHS Committee approves or disapproves the referrals based on medical facts and CHS Criteria being met. This committee is the only authority to approve or disapprove.
IN MOST CASES AN APPROVED REFERRAL IS LIMITED TO ONE MEDICAL TREATMENT AND/OR ONE
Please call Contract Health Services at 395.4486 prior to any follow-up appointments for approval to make sure your coverage is still in effect.
CHS is the payor of last resort. When a patient has Medicare, Medicaid, Veterans Assistance, CAMPUS, Private Insurance Workman's Compensation, or covered by any other resource, the resource is the primary carrier. All Explanations of Benefits (EOB's) from the primary carrier(s) must be brought or mailed to the CHS office without delay when received by the patient. Many times the non-IHS provider will turn the patient's bill over to collections because they are unable to collect the Explanation of Benefits from the patient. The non-IHS provider cannot collect payment for IHS until they have filed the Bill with EOB. Therefore, it is crucial for the patient to provide the EOB either to the non-IHS provider or the Contract Health Services Office in order to complete the payment process.
THE PATIENT MUST APPLY FOR ANY ALTERNATIVE RESOURCES FOR WHICH THEY MAY BE ELIGIBLE. DENIALS FOR ALTERNATE RESOURCES MUST BE PRESENTED TO CHS OFFICE.
Non-compliance with approval process may serve as the basis for denial of payments by CHS.
Contract Health can be reached at 406.395.4486
Michelle Koop - Ext. 1690 - Referrals & Appointment Scheduling
Shelbi Eagleman - Ext. 1692PRC Assistant - If you have questions regarding Hospital Bills, please contact Shelbi, as she works with Northern Montana Hospital Bills from A to L
Julie Nault - Ext. 1691
PRC Assistant - If you have questions regarding Hospital Bills, please contact Shelbi, as she works with Northern Montana Hospital Bills from M to Z.
Linda Nault - Ext. 1689 - PRC Specialist - Ext 1689 - works with all Benefis Hospital and Benefis Medical Group Bills.
All other calls or questions will be sent to Julie or Shelbi.
Non-compliance with approval process may serve as the basis for denial of payments by CHS .