Overview

Business PRC (Purchase & Referred Care) Coordination

Direct Services

•    Coordinate referred care services across facilities
•    Coordinate transitional care with hospital discharge nurses and alternate resources
•    Assist patients in claim resolution and educate on PO# requirements
•    Coordinate care budgets with Behavioral Health and Dental
•    Manage Qualified Health Plan premium assistance
•    Coordinate Medicare Part B reimbursement under the NTM program
•    Coordinate benefits with onsite Olympia CSO case worker
•    Monitor high-cost cases for potential CHEF eligibility
•    We assure that the needs of Nisqually Tribal Members services are our top priority

Benefits Coordination & Registration

•    Screen patients losing or lacking coverage for WA Health Plan Finder options
•    Confirm active alternate coverage before appointments
•    Identify managed care options for Behavioral Health patients
•    Assist with Medicare and Disability Applications
•    Provide service access guidance and phone support for patients
•    Coordinate pharmacy refill authorizations and prescription access outside clinic hours
•    Facilitate elder invoice payments for group and long-term care
•    Assist with SUD/MH payment coordination and funding monitoring
•    We assure that the needs of Nisqually Tribal Members services are our top priority

Referrals

•    Find suitable providers locally and out-of-area
•    Coordinate DME and supply needs for hospital/rehab discharges in partnership with PRC
•    Establish and maintain relationships with external providers
•    Support patients with transportation, appointments, and insurance questions
•    Guide Direct Care patients on financial responsibility for services
•    We assure that the needs of Nisqually Tribal Members services are our top priority
 

 Address: Nisqually Tribal Health & Wellness Center, 4840 Journey Street SE, Olympia WA 98513

Phone: (360) 459-5312, Option 6

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