Medical Referrals In/Out of the SEARHC System



About the Patient Travel Office and Purchased/Referred Care (PRC)

Like many healthcare systems, SEARHC relies on providers outside of SEARHC to complete some kinds of specialized treatment. Sometimes emergencies happen where SEARHC can't provide service. This is where the SEARHC Travel Office and SEARHC Purchased/Referred Care come in.

Patient Travel Office

Our patient travel office is here to meet your travel needs between your community and Mount Edgecumbe Hospital/ANMC. Please work with your local clinic for referrals to Mount Edgecumbe/ANMC.

Purchased/Referred Care (PRC)

PRC funding for referred medical services not directly available at the SouthEast Alaska Regional Health Consortium (SEARHC). The PRC case management unit is a service available to all PRC funding eligible patients. The PRC RN utilization case manager works with SEARHC beneficiaries, their physicians and other health care team members to get the health care services the patients' need, and when they need them. If you request PRC funding and you are denied, the RN utilization case manager will work with your health care team to identify other resources.

Getting Started

Basic Guidelines to Patient Travel and Purchased/Referred Care

  • If it is not an emergency, authorization is required before treatment is started
  • A SEARHC physician must initiate all referrals for medical care
  • A referral does not mean automatic coverage. When the patient is referred outside, PRC must approve medical care. This gives SEARHC an opportunity to notify patients if there will be uncovered expenses and you discuss treatment options.
  • In order for SEARHC to cover the cost of outside emergency medical care, PRC must be notified within 72 hours of the start of emergency services (65 years and older have 30 days to notify)
  • All IHS facilities must be utilized instead of private facilities

Qualifying for Services

To qualify for services from Travel and Purchased/Referred Care, you must meet the following criteria:

  • Alaska Natives and American Indians who are Alaska residents for the prior 180 days and who intend to remain in Alaska indefinitely
  • Alaska Natives and American Indians who meet SEARHC's eligibility policy requirements
  • Non-Indian women who are pregnant with an eligible Alaska Native or American Indian man's child. American Indian man's child up to six weeks post partum
  • Children of an eligible Alaska Native or American Indian, including non-Indian foster children, adopted children, stepchildren, legal wards or orphans, until they reach the age of 19

Treatment not covered by SEARHC's Patient Travel and Purchased/Referred Care

  • Medical services provided by a non-tribal facility or provider that has not been authorized by the PRC
  • Medical services provided by a non-SEARHC health care provider that have not been referred by a SEARHC physician and authorized by SEARHC PRC case management
  • Obstetric deliveries at non-tribal hospitals, unless a life-threatening emergency
  • Inpatient or outpatient mental health services
  • Inpatient or outpatient substance abuse treatment programs
  • Medical care considered investigational or experimental
  • Nursing home or long-term care facilities
  • Routine dental services
  • PRC will not authorize payment for a non-tribal facility if a tribal health facility was open and available to provide the needed care
  • This is not an all-inclusive list. Please contact your PRC RN utilization case manager or the PRC about coverage, if you have any questions