24760 Hospital Drive
P. O. Box 497
Red Lake, MN 56671
218-679-3912 Main Phone
Contract Health Services
The Contract Health Services is funded annually by U.S. Congress. It is not an entitlement program or an insurance program. The IHS cannot guarantee that funds are always available. The Contract Health Services Program has guidelines set forth which determine the services that it can and cannot pay for.
Basic policies and regulations that apply in determining eligibility for Contract Health Services:
You must meet the first two conditions:
These are general guidelines, there are other CHS eligibility considerations that you may qualify for; these exceptions are handled on a case-by-case basis.
Managed Care Process
Contract Health referrals are prioritized by the attending
physician using the Medical Priority Guidelines; these referrals are reviewed by the Managed Care Committee which are held weekly with the medical providers and CHS staff. Emergency referrals are arranged at the time the patient is seen in ER/Urgent Care. ER records from outside facilities are also
reviewed; purchase orders are issued for the approved visits and letters are generated for the visits that are denied explaining the reason it was denied.
Transportation to Appointments
Transportation is available for patients that are referred to an outside facility. Referral slips are completed and delivered to the Transportation Director who arranges the trips. Transportation is not provided to patients that prefer to have their routine medical care at another medical facility.
Medical & dental referrals are received on a daily basis; each referral is researched for other alternate resources that may be available. Medical referral with active Medicaid are scheduled, all other referrals are reviewed at the weekly Managed Care meeting. After the meeting the approved referrals are scheduled, referrals that did not meet the guidelines are documented in the CHS Deferred Report and letters are sent to the patient informing them of the Managed Care decision.
The CHS staff works closely with the Patient Benefit Coordinator (PBC); PBC assists patients with applying for other alternate resources they may be eligible for. PBC contacts patients regarding alternate resources and explains the importance of completing the alternate resource application.