Policies & Guidelines
- Compliance
- Definitions
- Ambulatory Surgical Services
- Billing Policy
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Legal References
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- Ambulatory Surgical Services
- Billing Policy
- CFSS
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- Equipment and Supplies
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Member Eligibility
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Quality: HEDIS
- Policies & Procedures
Tribal and Federal Indian Health Services
Definitions
Facility Support Staff: Individuals employed by the health care facility to support the services provided by the facility’s health professionals. These individuals do not generate billable encounters. Examples of facility support staff are: clinic managers, registered nurses (RNs) and licensed practical nurses (LPNs) not functioning/acting as physician extenders or visiting nurses, lab technicians, and X-ray technicians.
Indian Health Service (IHS) Facility: A hospital, medical or dental clinic, or pharmacy established and operated by the Federal IHS.
IHS Inpatient Per Diem Rate: The IHS inpatient per diem rate is the payment amount established to cover services provided to an inpatient at a hospital that is part of the Federal IHS. PrimeWest Health does not reimburse at the IHS Federal encounter rate.
Outpatient Encounter: An encounter means a face-to-face visit between a member and any health professional at an IHS or tribal facility. Multiple encounters with the same professional or with more than one health professional, within the same service category, on the same day, at a single IHS or tribal location, constitute a single encounter. An exception to this is when the member, after the first visit, suffers an illness or injury requiring additional diagnosis or treatment.
Tribal 638 Facility: Tribally owned facilities funded by Title I or III of the Indian Self-Determination and Education Assistance Act (Public Law 93-638), including all facilities under contract, compact, or receiving grants from the IHS. The tribal facility is operated by a Federally recognized tribe under a funding agreement with IHS. Tribal facilities may elect to be paid at the IHS rates or at fee-for-service rates.
Tribal Facility: A health care facility operated by a tribal organization that is recognized by the Federal government that has not elected designation as a 638 IHS provider. This includes all 638 facilities that are not listed with the Minnesota Department of Human Services (DHS) as IHS facilities. Services provided to PrimeWest Health members by an enrolled tribal facility are covered if the facility meets the requirements to provide services as specified in Requirements All Providers Must Meet.
PW_03-19_150
Updated_03/14/2019
