(Formally known as Contract Health Services)
Tracey Conant
HEALTH SERVICES NAVIGATOR
P: (231) 242-1600
Tracey issues reference numbers for appointments outside of Mina-Mskiki Gumik; manages the Elder’s Dental Program and the Hearing Aid Program; and assists patients with any questions or concerns they may have regarding PRC coverage.
VALORIE GLAZIER
LTBB SPONSORSHIP SPECIALIST
P: (231) 242-1748
Valorie works closely with patients that are eligible for PRC’s Medicare Part B and Part D Reimbursement Programs. She also assists the Patient Benefits Specialist in processing Medicaid applications and insurance questions.
KELLI PAMP
CENTRAL REGISTRATION CLERK
P: (231) 242-1747
Kelli checks in all patients for their appointments at the LTBB Health Department. She ensures patient demographics are up-to-date and are compliant with our federal regulations.
MEGHAN FISCHER
PRC REFERRAL SPECIALIST
P: (231) 242-1600
Meghan works alongside the LTBB Clinical Staff to ensure referrals are submitted to outside providers and approval is obtained through PRC’s Managed Care.
MARCIA SUTTON
PRC SPECIALIST
P: (231) 242-1600
Marcia maintains a wealth of knowledge regarding the PRC Program. She assists patients through complex outside referrals, processes dental claims, Reimbursement cases, approved mileage/hotel accommodations, and a member of the Managed Care meetings.
CHRIS WEMIGWASE
PRC ASSISTANT
P: (231) 242-1600
Chris processes payments for outside providers that have been approved for coverage by PRC. She also assists patients with questions or concerns regarding account payments or statements they may receive in the mail.
NEEWIN WEMIGWASE
PRC ASSISTANT
P: (231) 242-1600
Neewin processes payments for outside providers that have been approved for coverage by PRC. He also assists patients with questions or concerns regarding account payments or statements they may receive in the mail.
LISA BROOKINS
PRC ASSISTANT
P: (231) 242-1600
Lisa processes payments for outside providers that have been approved for coverage by PRC. She also assists patients with questions or concerns regarding account payments or statements they may receive in the mail.
JADE BARNES
PRC MANAGER
P: (231) 242-1600
Jade oversees the PRC Program. She works closely with her team to keep operations running smoothly. She also assists with complex referrals, maintaining relationships with providers, and supporting patients with unresolved issues.
PRC is an Indian Health Service that is a U.S. federally funded program run by the Little Traverse Bay Bands of Odawa Indians (LTBB) Health Department. It is the means used to pay for services that cannot be provided at the Mina-Mskiki Gumik Clinic for patients who are eligible for coverage. PRC is the payer of last resort. All insurances, including Medicaid, or other resources must be billed and exhausted before payment is made through PRC.
Please note: This program has strict federal guidelines that must be followed. PRC is not an entitlement program or insurance plan. Payment can only be guaranteed through prior authorization with PRC.
To be eligible patients must meet the following criteria:
There are also patients who can temporarily qualify for PRC eligibility. These include:
When a patient meets the eligibility requirements for PRC, they can receive coverage through the program. However, payment cannot be guaranteed without prior authorization. There are two ways a patient can receive prior authorization.
First, is by obtaining approval from the Managed Care team. The team’s function is to review and prioritize PRC referral requests and notifications regarding emergency episodes of cared based on Medical Priorities of Care, as well as to review and monitor the referral and expenditure of PRC funds. The team consists of the Clinic Nurse Manager, PRC Referral Specialist, PRC Specialist, and the PRC Manager. Managed Care meets on a weekly basis on Tuesdays at 10 am. However, the date is always subject to change. Patients will receive a letter in the mail with the determination for coverage.
Services and procedures that require Managed Care approval include, but are not limited to:
Second, is by obtaining a reference number from the Health Services Navigator. There are certain services and procedures that do not require the approval of the Managed Care team. If a patient maintains yearly compliance with PRC, they may call the Health Services Navigator 24 hours in advance of their appointment to obtain a reference number.
Services and procedures that do not require Managed Care approval include, but are not limited to:
If a patient has any questions or concerns regarding these authorizations, they should contact the Health Services Navigator at (231) 242-1600.