Under specific conditions, Perkins Family Clinic (PFC) Contract Health Services (CHS) provides funding for referred medical services not directly available at PFC. However, only limited CHS funding is available. To ensure wise stewardship of those funds, PFC has specific policies and procedures concerning their use. If an individual does not follow the policies and procedures, PFC CHS may be unable to assist with the cost of medical services a person receives at non-PFC facilities.

This website is designed to help you understand your role and responsibilities in following PFC CHS policies and procedures.

 Other CHS and regional programs providing health coverage

You may be eligible for CHS funding from the tribal entity providing health care in your region or to your tribe's members if you are a resident of an area other than that covered by the PFC CHS program. You will need to contact them and follow their policies and procedures.  

Criteria and documentation

A referral made by a PFC physician does not guarantee payment. PFC CHS does not deny medical services, however, referred services must fall within approved CHS medical priorities to be considered for payment. If a service is not covered by CHS, the patient will be financially responsible for services received. 

 *When a patient is referred by a PFC physician and CHS has authorized payment, it is the patient or patient's family ultimate responsibility to ensure that CHS receives all claims and/or applicable insurance information in a timely manner. CHS will not be responsible for delinquent patient accounts due to untimely submission of claims and/or insurance information.

Q. What is Contract Health Services?

Contract Health Services (CHS) provides funding for referred medical services not directly

available at the Perkins Family Clinic (PFC). Due to limited funding there are policies

and procedures that must be followed. PFC CHS may be unable to assist with the medical cost

received from non-PFC facilities if policies and procedures are not followed.

Q. What are Alternate Health Resources (AHR)?

Alternate Health Resources are other payor sources such as Medicare, Medicaid, private health

insurance, workers’ compensation, automobile insurance, etc.

Q. Do I have to apply for Alternate Health Resources?

Yes. Per federal regulations CHS is the payor of last resort. All alternate health resources that a

patient has available or may be eligible for must be applied to before a claim will be considered

for payment by PFC CHS. (Federal regulation 42 C.F.R. 136.61).

Q. What happens if I don’t apply or fail to complete the application process for AHR?

PFC CHS will not consider your claims for payment if you do not apply for AHR or complete the

application process. The cost of your medical services will be your financial responsibility.

Q. Do I need to notify PFC CHS within 72hours for all emergency care?

Yes. All emergent medical services received outside of PFC needs to be reported within

72hours. This includes ground ambulance. Calls must be made to the PFC CHS department (1-

405-547-2473 ext 233). Leave a voice message if you are calling on holidays or weekends. Notification

does not guarantee payment.

Q. Is payment guaranteed just because PFC referred my care?

No. Referrals are not a guarantee of payment, they are recommendations for treatment. PFC

CHS reviews every referral according to Federal regulations and CHS policy in order to determine

authorization for payment. Patients must comply with screening for alternate health resources

and other PC CHS policies.

Q. Does PFC CHS provide funding for medical services received anywhere in Oklahoma?

No. There are several CHS programs throughout the State which may provide funding

within their respective region. In addition, some associations and corporations may also provide

funding.

Q. Do I need a referral for every medical visit that I receive outside of PFC even if it is a

follow up?

Yes, unless otherwise notified you should receive authorization from a PFC physician for

every follow up visit. There may be exceptions for patients receiving dialysis or radiation

treatment but ALWAYS verify with your primary care provider at PFC first.

Q. Does PFC CHS provide insurance coverage letters?

No. PFC CHS is not an insurance company.

Q. Who is responsible for ensuring that all bills, insurance information and other required

documentation is submitted to PFC CHS once referral has been approved for payment?

The patients or patient’s family is responsible for submitting all required documentation such as

medical records, additional insurance information, accident questionnaire, etc.

Q. What is the timely filing period?

Timely filing is within one year from the date(s) medical services were received. PFC CHS

operates on limited annual funding. Once funding has been exhausted PFC CHS will not be

able to provide payment for patients who do not submit the required documents within the timely

filing period.