Consolidated Tribal Health Project
Healthy People. Healthy Families. Healthy Community.

Billing & Payments

 

Billing & Payments

If patients receive a bill from a provider, they can bring it to the PRC office as soon as possible for review and approval. The patient will be informed as to whether or not all or part of the bill can be covered by PRC. If patients receive a payment from a provider for a bill that PRC already paid, the patient must reimburse PRC the amount.

The Sliding Fee Scale minimum advance payment is $50.00. This must be paid at the time of service or your appointment will be rescheduled.

 

PRC: Prior Payment Authorization

Prior payment authorization is required for all non-emergency services and follow-up visits. Only eligible AI/AN patients referred by CTHP providers to outside providers may receive assistance from PRC, depending upon funding availability. Each medical/dental follow-up visit and procedure or surgery must receive prior approval. Every referral needs prior authorization from CTHP PRC Program before service is rendered.

Secondary referrals made from other providers need to have prior authorization from PRC before service is rendered.

It is the patient’s responsibility to schedule and attend all referral appointments, and to arrange their transportation.

 

Payment / Bad Debt

Payment is due at the time of service. If the patient is unable to pay account balance in full, the patient contacts the Billing Department to set up a Payment Arrangement Contract. Patients are responsible for lab costs not covered by insurance, and will have ninety (90) days from date of service to pay their account. After 90 days, if patient has not made arrangements a “Final Notice” will be mailed. Patients have 14 days to pay the account after the “Final Notice” has been mailed; if no payment has been made, the patient’s account will go to collections.

Once an account is in collections, patient must pay the full amount of the collection debt and all current charges must be paid in advance for any future CTHP visits. If patient has insurance, Medicaid, Medicare or CMSP, the patient may be seen; however, the patient is still expected to pay the “Bad Debt” balance. The patient will be required to pay any co-pays and unmet deductibles in advance on future visits.

If coverage is terminated at any time, the patient will be required to pay in full at the time of service.

 

Questions?

Contact Michelle Edwards, Billing Supervisor, at 707-467-5617.

 

Medi-Cal Members:  Podiatry and Glasses Benefits

Starting February 1, 2015, Partnership HealthPlan of California (PHC) is adding the following benefits for PHC members:

Glasses
No charge for lenses and frames every two years for PHC members. For more information about this benefit, call Vision Service Plan at 1-800-877-7195.

Podiatry Services
Provided by a podiatrist, when needed. Referral from PCP required.

If you have any questions, please call PHC Member Services Department at 1-800-863-4155. They are available from Monday to Friday 8 am to 5 pm.