Billing and Purchased/Referred Care (PRC) FAQ’s

Written by Communications_Dept on . Posted in Newsletter Frontpage and Current

1. What is the breakdown between hospital and clinic as far as how the billing works?
When patients are seen at the hospital, PRC is alerted the following business day of these visits. PRC staff reviews each patient for Alternate Resources, Certificate of Indian Blood (CIB) and residency for the TCC Region. Once this process is complete, PRC sends the alert back to the hospital, noted on the alert whether the patient is approved or denied. A Purchase Order (PO) is issued for the approved, and denial letters are sent to the patient and provider for the non-covered patients. There are patients that do not list TCC or only list TCC when they have other insurance. For those that do not list PRC, TCC doesn’t know about their bill until they start receiving statements or have gone to collections. Make sure that you provide all insurance information to Fairbanks Memorial Hospital (FMH) and other vendors each time you visit as each encounter has a different account number.

2. I keep getting bills from the hospital who do I talk to?
Call Purchased/Referred Care @ 451-6682 ext. 3613 , and you will be transferred to the PRC biller that handles your part of the alphabet.

3. I was referred to a place in the community for care (ex: the sleep clinic) went to one apt and then a follow up and I got a bill?
Always call PRC if you’re not sure if you need a Purchase Order. Each Provider visit outside of CAIHC does require a Purchase Order. If you went to the appointment without a purchase order or have insurance and the insurance hasn’t paid, then you will receive a statement from that clinic until your insurance has paid. When you receive a statement you need to call PRC and talk to someone.

4. I need help understanding my bill(s) and Explanation of Benefits (EOB’s) who should I call?
Call PRC @ X3613 to get transferred to the correct biller that handles your part of the Alphabet.

5. Why would FMH and our other Vendors send me to collections when I was referred by TCC?
Management has been made aware of this situation and we are asking our vendors to let us know when patients are about to go to collections so that we can intervene before this happens. It is very important to contact PRC when you receive any billing statements or insurance explanation of benefits. We can help you understand why you’re receiving these