Contract Health Services
About Contract Health Services (CHS)
CHS is program apart of the Indian Health Services that may assist individuals with medical bills received from a non-I.H.S. facility; a limited amount of funding for special situations only. Not everyone is eligible. CHS is not an entitlement program and cannot guarantee payment even when there is a referral on file. Patient must meet certain criteria.
72 Hour Notifications
You must contact Contract Health Services within 72 hours of receiving emergency care at a non-I.H.S. facility. If you are unable to do so, have someone contact us (family, friends, Dr. & etc.)
- For Montezuma Creek & Bluff Call 435-651-3891 OR Fax CHS Dept at 855-848-8738
- For Blanding Area Call 435-678-4657 OR Fax Jaylene 801-657-4363
- For Monument Valley Call (435) 727-3028 OR Fax Charlene at (435) 727-3001
Frequently Asked Questions
- Who is Eligible?
- You must be of Navajo descent or be a non-Indian woman pregnant with an eligible Navajo’s child. If you are a member of another Native American tribe, you must have social and/or economic ties to the Navajo Reservation to be eligible for CHS.
- You must have a CIB on filed with CHS.
- You must live within the Utah Navajo Health Systems’ CHS Delivery Area for 180 days. If you are unsure about whether or not you reside within our area, please call one of our offices and ask what service unit you reside in.
- Your specialty health care needs must be listed on the medical guidelines used by Contract Health Services to determine eligibility.
- CHS payer of last resort therefore, you must apply for Medicaid or other insurances you may be eligible for. If you are denied, we need a denial letter with legitimate denial reasons on file to let us know you’ve attempted to apply for Medicaid. If you were denied Medicaid due to non-compliance to turn in documents or complete Medicaid process, you will be asked to reapply for Medicaid again.
- You must contact Contract Health Services within 72 hours of receiving emergency care at a non-I.H.S. facility. If you are unable to do so, have someone contact us (family, friends, Dr. & etc.)
- For non-emergent services, you must obtain a prior-approved referral from a physician at Utah Navajo Health Systems.
- What do I do if I.H.S. doesn’t have the services I need?
- If your doctor believes you need specialty care at a non-I.H.S. facility, he or she will fill out a form called a “Referral Form.” This is given to Contract Health Services. We will then present it to our case management & medical review board to determine your specialty service within medical priority and your case is needed right away. If it is not needed right away, we will ask you to apply for Alternate Resources such as Medicaid so they may help you pay for these services.
- We will only consider referrals made within our offices. You will need a referral to see a specialist in order for us to pay for these services. So make arrangements with your primary care provider at Utah Navajo Health Systems, INC.
- If a referral is obtained from another I.H.S. facility, that facility is responsible for paying for that service. Under “He who refers Pays” policy, regardless of where the patient resides, the referring facility’s CHS is responsible for that episode of care. Please submit outstanding medical bills to the referring facilities for services you were sent from that facility for.
- Contract Health Services does not cover certain Specialty services, Eyeglasses, Hearing Aides, major dental services and pharmacy services received outside an I.H.S. pharmacy such as Wal-Mart.
- What if I need emergency services right away?
- If you receive emergency care from a non-I.H.S. facility, you must give Contract Health Services a 72 hr notification (3 business days). If you don’t do so, you will receive a denial letter for no 72 hr notification. We will only make an exception for elder’s age 65 & over and mentally handicapped to provide us notification within 30 days of services.
- If the nearest healthcare facility was I.H.S. and you still decided to go to a non-I.H.S. facility, CHS will not pay for the medical bills unless it is a life-threatening situation. Our medical review board will make the medical priority determination.
- Your care must be medically emergent to obtain approved services from an ER Dept. Contract Health Services will not consider Urgent Care and Non-Urgent Care needs. Most Insurance/Medicaid abided by the same policy.
- What if I’m away at school?
- As a college student, Contract Health will pay for healthcare you receive from a non-I.H.S. facility if there is no I.H.S. facility within 30 miles of your school and if the service is approved as medically emergent.
- You will need to verify that you are a full time college student by giving us a copy of your admissions letter, class schedule & submitting a CHS Student Application indicating that you are enrolled. Otherwise, we will not cover medical bill.
- CHS does not cover part-time students.
- You must apply for Medicaid & other Alternate Resources such a Student Medical Insurance through the school if the school offers the program. Always ask the school admission’s office if they carry such coverage. It’s worth it to purchase this insurance especially if there is no I.H.S. facility nearby and financial aide may assist you by purchasing this coverage for you.
- Any medical services incurred are still considered under medical priority by the medical review board.
- It is better that you take care of any routine medical & dental needs at your local I.H.S. facility before going off to college such as routine dental care, physicals and etc.
- What if I get denied? What do I do?
- If your request for Contract Health Service funding is denied, you will receive a denial letter informing you of the denial and why the decision was made. The facility you’ve received medical service from will also receive a copy of the exact denial letter sent to you so they have the same information you’ve received.
- Sometimes all that is needed is more information such copy for your C.I.B. or you may need to apply for Utah Medicaid or other alternate resources that you may be eligible for. If you’ve applied for Utah Medicaid already and were denied, please submit it ASAP! The denial letter must be dated within the last 6 months. If it has been more than 6 months since you’ve applied for Medicaid, you will be asked to reapply. If you were denied Utah Medicaid because you failed to provide documents, comply with their requests or was denied because you did not complete Medicaid application, you will be denied Contract Health Services funds. You will be asked to reapply for Medicaid again.
- You have 30 to request an appeal in writing you may mail it to our office or drop it off in person at one of our offices in Montezuma Creek Health Center, Blanding Family Practice or Monument Valley Clinic. Please include all supporting documents with your appeal to support your case. Your case will be reviewed at the next case management/medical review board meeting following your appeal remittance.
To submit claims and/or appeal letters, please mail them to:
Utah Navajo Health Systems, INC
Attn: Contract Health Services
PO BOX 18, Montezuma Creek, UT 84534
****Please allow 1-2 weeks for case to be reviewed. It may be longer depending on amount of case load we may have.
****If you have primary insurance coverage, please include a copy of your primary insurance’s Explanation of Benefits (EOB) with your inquiry. If you do not include your EOB form, it will cause a delay in your case process cycle.
(NOTE: Most insurance companies will not allow CHS to obtain the Explanation of Benefit forms due to Privacy Law therefore the patient is responsible for obataining the Explanation of Benefit form for the specific service date he/she applies for.
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