New Purchased/Referral Care (PRC) regulations give the Indian Health Service (I) , Tribal Organizations (T) and Urban Indian Organizations (U) the ability to cap payment rates at a "Medicare-like rate" to physicians and other non-hospital provides and suppliers. PRC covered services include outpatient care, physicians, laboratory, dialysis, radiology, pharmacy and transportation services. The effective date of the regulations was May 20, 2016, with an implementation date of no later than March 21, 2017. In the absence of a contract or agreement with I/T/U for a different rate, the PRC "Medicare-like rate" applies when a Provider accepts a referral or request for services, accepts a purchase order for services, or files a claim for payment for an I/T/U patient. Under the coordination of benefits provisions, PRC is a residual resource and pays after all other resources have considered the claim. Federal law prohibits the provider from billing the I/T/U patient for authorized care.
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