What is Purchased & Referred Care?

Purchased & Referred Care (PRC), formerly called Contract Health, helps eligible patients receive care by funding referrals outside of Cherokee Nation Health Services (CNHS) or Indian Health Service (IHS) when those services are not available within our health system.

Important: If you receive a referral from a CNHS provider, PRC funding is not guaranteed. Approved referrals are good for one visit, and each additional referral must meet eligibility requirements and funding guidelines.

Who is eligible?

You may be eligible for PRC if you:

  • Are an enrolled member of, or eligible for membership in, a federally recognized Tribe.

  • Live within the Cherokee Nation PRC service area.

  • Meet all PRC eligibility and notification requirements.

You may be asked to provide proof of residency.

Residency exceptions

You may still qualify if you are:

  • A full-time college student temporarily living away from your Oklahoma residence.

  • Temporarily away from home for work (up to 180 days).

  • Within 180 days of moving outside the Cherokee Nation PRC service area.

How does the referral process work?

Step 1: Your provider determines you need specialty care or services not provided within our health system.

If your CNHS or IHS provider determines that your medical needs cannot be treated within our health system, they will submit a referral.

Step 2: PRC reviews your referral.

CNHS staff will:

  • Verify your eligibility.

  • Confirm your PRC service area.

  • Review your referral based on medical need and available funding.

Step 3: You receive a decision.

You will receive notification via Patient Portal if your referral funding is approved or denied.

If approved:

  • You will receive referral paperwork to take with you to your appointment. This will be uploaded to your Patient Portal, or you can pick this up in-person at your preferred CNHS Health Center.

  • You will be contacted by the PRC Team and/or the specialist’s office to schedule your appointment.

If denied:

  • You will receive information explaining why your referral was denied via Patient Portal and mail. Instructions and deadlines for filing an appeal will be included. Up to three appeals are permitted per referral.

  • You can bypass the appeal process and proceed with your appointment as self-pay, if desired.

If assigned to another PRC service area:

  • Your referral will be sent to the Tribe whose PRC service area you reside in. Service area eligibility is based on your permanent address. You can call 1-877-CNHS-PRC (1-877-264-7772) or email cnhs-prc@cherokeenationhealth.org if you need assistance determining if your residence falls within a PRC service area.

  • Nearby PRC service areas include:

    • Bearskin Wellness Center (Wyandotte): 888-864-0725

    • Choctaw Nation: 580-567-7000

    • Muscogee Creek Nation: 918-758-2710

    • Northeast Tribal Health System: 918-542-1655

    • United Keetoowah Band: 918-871-2833

How are referrals prioritized?

PRC reviews referrals based on several factors, including:

  • Whether the condition is life-threatening or could result in loss of life or limb.

  • How the illness or injury affects your health and ability to perform everyday activities.

  • Available funding.

Because PRC funding is limited, not every medically necessary referral can be approved.

Before Your Appointment

It is your responsibility as the patient to verify that your referral has been approved for funding prior to your appointment. You will need to bring the following to your appointment:

  • Your PRC referral paperwork

  • Your insurance cards (Medicare, Medicaid, private insurance, etc.)

  • Any requested medical records or imaging, such as X-rays or CT scans

Health Coverage Requirements

PRC is the payer of last resort. This means all other available insurance or financial assistance must be used before PRC can pay.

If you do not have insurance, you must apply for any programs for which you may qualify, such as Medicaid or other assistance. A CNHS Patient Benefit Coordinator (PBC) will reach out to help you explore available coverage options.

Failure to complete required insurance or assistance applications may result in you being responsible for medical bills.

Emergency Care at a Non-CNHS Hospital

If you have a medical emergency:

  • Call 911 or go to the nearest emergency room immediately.

After receiving emergency care:

Step 1: Notify PRC as soon as possible.

You, a family member, or a friend must contact your the PRC office within 72 hours if you receive emergency care or are admitted to a non-tribal hospital. Patients aged 65 and older or with disabilities have 30 days to notify PRC.

Step 2: Complete the required paperwork.

After notification, PRC will mail you an information and appeal packet. Complete and return the requested documents as instructed.

Please note that patients whose funding is managed by another IHS or Tribal service unit must contact their assigned service unit directly.

Frequently Asked Questions

No. A referral allows PRC to review your request. Payment depends on eligibility, medical priority, notification requirements, and available funding.

Each referral is valid for one date of service only. If your appointment changes or additional testing or follow-up visits are needed, your provider must submit a new referral.

Contact the PRC office at 1-877-CNHS-PRC (1-877-264-7772) or email cnhs-prc@cherokeenationhealth.org before your appointment to verify that your referral has been approved.

Yes. Appeal instructions are included with every denial notice. Up to three appeals are allowed for each denied referral.

You can present in-person at your Health Center’s PRC office, call 1-877-CNHS-PRC (1-877-264-7772), or email cnhs-prc@cherokeenationhealth.org for assistance.

Download

PRC Information Sheet

256 KB / Created September 2, 2026 / Updated September 2, 2026

This document provides an overview of Purchased & Referred Care guidelines, eligibility, and more.

Updated August 31, 2026