{"meta":{"key":"d012--programs-08","task":"D012","title":"Medical and care debt: federal program-rule source supplement","parent_title":"Medical dental and long term care debt","edition":"programs-08","path":"/research/d012--programs-08/","kind":"correction","category":"subject","role":"foundation","area_numbers":[16],"groups":["debt-types"],"date":"2026-10-26","tables":5,"claims":1,"sources":7,"review_status":"bounded_patch_resolved_by_programs09_remaining_program_holds","review_complete":true,"sha256":"8f2f553f263eb7521be68989859a941d3d890e34369653e89fc0033093b59f83","headings":["1. Controlling federal statute","2. Operational findings — authorization, eligibility and appeals","Who is responsible for payment?","Appeal sequence","3. Source register — preserved and new IDs","4. Replacement claim record — D012-C039","5. Publication-ready replacement wording","Can an outside medical provider bill a patient for IHS Purchased/Referred Care?","6. Hypothetical examples","7. Coverage and residual-gap table","8. Researcher self-check"],"generation_provenance":{"actual_route":"regular_chat_adaptive_models","actual_model":"GPT-6","actual_mode":"Pro","provenance_limit":"Actual documented capture labels only; missing labels remain unknown. No preferred setting is inferred as actual execution."},"public_id":"D012/programs-08","facets":{"geography":["us","us-federal"],"debt_type":["medical","dental"],"stage":["appeal"],"subject":["provider-licensing","appeals","medical-assistance","employment-care-benefits"]},"scope":"","pending_corrections":0},"markdown":"# SettleADebt.com — D012 PROGRAMS-08\n\nFocused primary-source correction | A016 — Indian Health Service Purchased/Referred Care (PRC) | Baseline and verification date: October 22, 2026, Pacific\n\nDisposition: Federal no-patient-liability protection verified. Operational authorization, eligibility, payer coordination and appeal procedures require separate qualifications.\n\nThis supplement addresses only D012-S035 and D012-C039. Existing D012 source IDs S001–S051 and claim IDs C001–C056 remain preserved.\n\n## 1. Controlling federal statute\n\nThe operative statutory source is 25 U.S.C. § 1621u, titled Liability for payment. The Office of the Law Revision Counsel's current text includes laws through Public Law 119-120, October 7, 2026. uscode.house.gov\n\nThe statute has three distinct provisions.\n\n| Pinpoint | Operative rule | Important qualification |\n| --- | --- | --- |\n| § 1621u(a) | A patient receiving IHS-authorized contract health care services is not liable for charges or costs associated with those services. | The protection attaches to qualifying authorized services, not every medical service received by an IHS patient. |\n| § 1621u(b) | The Secretary must notify the contract-care provider and patient of the patient's nonliability within five business days after receiving the provider's claim notification. | This is a notification obligation triggered by receipt of a qualifying claim notification, not a universal five-day deadline for approving every referral. |\n| § 1621u(c) | Following the statutory notice, or where a claim is deemed accepted under § 1621s(b), the provider has no further recourse against the patient. | The separate deemed-acceptance mechanism matters; authorization and claim acceptance should not be conflated. |\n\nThe current statute reflects amendments enacted in 2010. Its editorial notes also reproduce a 2020 congressional rule of construction preserving the IHS patient-liability protections against displacement by the federal surprise-billing legislation. uscode.house.gov\n\nCritical distinction: A medical referral, clinical recommendation, or treatment at an outside facility is not, standing alone, proof that IHS authorized payment under PRC.\n\nThe protection should not be described as a universal waiver of every medical debt incurred by an eligible American Indian or Alaska Native patient.\n\n## 2. Operational findings — authorization, eligibility and appeals\n\nIHS's published PRC materials identify the practical conditions that determine whether the statutory protection applies.\n\n| Issue | Finding | Primary pinpoint |\n| --- | --- | --- |\n| Referral versus authorization | A referral is a clinical recommendation, not a guarantee of payment. PRC must separately determine payment authorization. | IHS PRC FAQ, “An IHS doctor refers me to a specialist…” Purchased/Referred Care (PRC) |\n| Authorization document | PRC ordinarily issues an IHS-843-1A Order for Health Services to authorize specific outside services. | IHS PRC Resources, “IHS-843-1A.” Purchased/Referred Care (PRC) |\n| Nonemergency authorization | 42 CFR § 136.24 generally requires advance notice and an appropriate purchase order. Limited exceptions permit later notification and waiver of advance notice. | IHS regulation reproduction, § 136.24(a)–(b). Resources |\n| Emergency notification | The regulation generally requires notification within 72 hours after emergency treatment begins or admission occurs, with extensions for impracticability or other good cause. | § 136.24(c). Resources |\n| Eligibility | PRC eligibility depends on applicable tribal affiliation, residence or delivery-area rules, notification, medical priority and other requirements. PRC is not an entitlement program. | IHS Purchased/Referred Care for Patients. for Patients |\n| Other payers | PRC operates as a payer of last resort, requiring examination of available Medicare, Medicaid, private insurance and other alternate resources. | IHS PRC patient guidance and manual, including § 136.61 references. for Patients+1 |\n| Claim-response rule | Under 25 U.S.C. § 1621s, IHS generally must respond to a qualifying provider claim notification with a purchase order or denial within five working days. The deemed-acceptance rule depends on a sufficiently complete qualifying claim. | IHS Manual, Part 2, Chapter 3, § 2-3.21. Part 2 |\n| Administrative appeals | Denials require written notice with reasons. Under 42 CFR § 136.25, reconsideration or appeal generally must be requested within 30 days after receipt of the applicable notice. | IHS PRC Appeal Process, § 136.25(a)–(c). Purchased/Referred Care (PRC) |\n\n### Who is responsible for payment?\n\nFor qualifying authorized services, § 1621u protects the patient against liability for the associated charges.\n\nThe outside provider's payment claim is directed through the applicable PRC payment process, with other available payers considered under coordination rules. The precise amount and source of reimbursement can depend on the purchase order, coverage, applicable payment limitations and claim adjudication.\n\nThis does not establish that IHS must pay every amount appearing on an outside provider's invoice.\n\n### Appeal sequence\n\nFor a denial governed by 42 CFR § 136.25:\n\n1. The applicant receives written denial reasons. Within 30 days after receipt, the applicant may request reconsideration from the Service Unit Director with additional supporting information, or appeal to the Area/program director without additional information.\n2. If reconsideration is denied, the applicant may appeal to the Area/program director within 30 days after receiving that decision.\n3. If the Area/program director affirms the denial, the applicant may appeal to the IHS Director within 30 days after receiving that decision. The Director's decision is final administrative action under this regulation.\n\nThese are regulatory administrative-review periods, not universal court-filing deadlines. Specific notices, applicable program arrangements and any different governing procedures must be checked. Purchased/Referred Care (PRC)\n\n## 3. Source register — preserved and new IDs\n\nAll sources in this table were opened and relevant passages read on October 22, 2026, Pacific, except the original historical-access assertion, which remains unverified. An undated IHS page is not assigned an invented publication or effective date.\n\n| Source ID | Issuer, direct URL and pinpoint | Version, jurisdiction, access and limits |\n| --- | --- | --- |\n| D012-S035 | Congress/OLRC, 25 U.S.C. § 1621u — Liability for payment. [https://uscode.house.gov/us/usc/119-120/t25/s1621u/](https://uscode.house.gov/us/usc/119-120/t25/s1621u/?utm_source=chatgpt.com) — subsections (a)–(c), 2010 amendment note and 2020 rule-of-construction note. | Opened/read. Current federal statute through Public Law 119-120 (Oct. 7, 2026). Original researcher access assertion not independently corroborated. uscode.house.gov |\n| D012-PR8-S001 | IHS, Purchased/Referred Care, patient overview. [https://www.ihs.gov/forpatients/prc/](https://www.ihs.gov/forpatients/prc/?utm_source=chatgpt.com) — paragraphs on referral, eligibility and alternate resources. | Opened/read. Current agency operational explanation; publication date not established. for Patients |\n| D012-PR8-S002 | IHS, Resources: Regulations — 136.24. [https://www.ihs.gov/prc/resources/resources-regulations-136-24/](https://www.ihs.gov/prc/resources/resources-regulations-136-24/?utm_source=chatgpt.com) — § 136.24(a)–(c). | Opened/read. Official agency reproduction of federal authorization regulation. Current eCFR amendment history not independently audited. Resources |\n| D012-PR8-S003 | IHS, Frequently Asked Questions. [https://www.ihs.gov/prc/frequently-asked-questions-faq-s/](https://www.ihs.gov/prc/frequently-asked-questions-faq-s/?utm_source=chatgpt.com) — “An IHS doctor refers me to a specialist…” and alternate-resource questions. | Opened/read. Agency interpretation; referral is not payment authorization. Purchased/Referred Care (PRC) |\n| D012-PR8-S004 | IHS, Indian Health Manual, Part 2, Chapter 3, Purchased/Referred Care. [https://www.ihs.gov/ihm/pc/part-2/chapter-3-purchased-referred-care/](https://www.ihs.gov/ihm/pc/part-2/chapter-3-purchased-referred-care/?utm_source=chatgpt.com) — §§ 2-3.6, 2-3.8, 2-3.9, 2-3.11 and 2-3.21. | Opened/read relevant sections. Current published IHS operational manual; section-specific revision history not reconstructed. Includes explicit distinctions between federal IHS and tribal program procedures. Part 2 |\n| D012-PR8-S005 | IHS, Appeal Process. [https://www.ihs.gov/PRC/appeal-process/](https://www.ihs.gov/PRC/appeal-process/?utm_source=chatgpt.com) — reproduced 42 CFR § 136.25(a)–(c). | Opened/read. Agency page reproduces a 2017 CFR edition; the page itself is not proof of every later regulatory amendment. Tribal procedures may differ. Purchased/Referred Care (PRC) |\n| D012-PR8-S006 | IHS, PRC Resources. [https://www.ihs.gov/prc/resources/](https://www.ihs.gov/prc/resources/?utm_source=chatgpt.com) — “IHS-843-1A, Order for Health Services” and regulatory resource index. | Opened/read. Agency explanation of purchase-order documentation and authorization. Purchased/Referred Care (PRC) |\n\nFailed route: The preliminary OLRC viewer at `https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title25-section1621u&num=0&edition=prelim` returned “Page Not Found.” The direct official OLRC section URL under D012-S035 succeeded. No access workaround was used. US Code\n\n## 4. Replacement claim record — D012-C039\n\n| Field | Corrected record |\n| --- | --- |\n| Claim ID | D012-C039 — preserved |\n| Area | A016 / IHS / Purchased-Referred Care |\n| Precise claim | Under 25 U.S.C. § 1621u(a), a patient who receives qualifying IHS-authorized contract health care services is not liable for charges or costs associated with those services. Section 1621u(b) requires notice to the provider and patient within five business days after the Secretary receives the specified provider claim notification. Under § 1621u(c), following that notice or statutory deemed acceptance under § 1621s(b), the provider has no further recourse against the patient. |\n| Authorization condition | A referral or clinical recommendation alone does not establish PRC payment authorization. The applicable eligibility, notification and authorization requirements must be satisfied; § 136.24 generally requires an appropriate purchase order. |\n| Eligibility conditions | Applicable tribal affiliation, residency or PRC delivery area, medical priority, notification, available funding and alternate-resource requirements. |\n| Payment distinction | The patient's statutory nonliability for authorized services is distinct from determining which payer reimburses the provider and in what amount. |\n| Appeal process | Denial and reconsideration procedures under 42 CFR § 136.25, including qualifying written notices and generally 30-day administrative appeal periods measured from receipt of the applicable notice. |\n| Primary sources | S035 § 1621u(a)–(c); PR8-S001–S006, particularly § 136.24(a)–(c), § 136.25(a)–(c), IHS Manual §§ 2-3.6, 2-3.8, 2-3.9, 2-3.11, 2-3.21. |\n| Jurisdiction/status | U.S. federal Indian health statute and IHS program requirements, checked October 22, 2026. Tribal program administration and individual eligibility require separate verification. |\n| Evidence limits | No individual purchase order, provider claim, denial, appeal, tribal program agreement or actual alternate-payer record examined. Current eCFR amendment audit incomplete. |\n| Disposition | Revised — controlling statutory rule verified; operational framework supported; individual authorization and tribal-program questions held. |\n\n## 5. Publication-ready replacement wording\n\nWriting### Can an outside medical provider bill a patient for IHS Purchased/Referred Care?\n\nUnder 25 U.S.C. § 1621u, a patient is not responsible for charges associated with qualifying contract health care services authorized by the Indian Health Service. The statute also restricts a provider's ability to pursue the patient after the required notification or qualifying deemed acceptance of the claim.\n\nAn IHS referral is not the same as payment authorization. Purchased/Referred Care must determine whether the patient, service and request meet the applicable requirements, which can include residency, medical priority, notification and use of other available coverage. The program ordinarily documents authorization through a purchase order.\n\nWhen an outside provider sends a bill for care believed to have been authorized, the key records are the PRC authorization or purchase order, the provider's claim, any IHS payment or denial notice, and other payer information.\n\nIf PRC payment is denied, federal IHS procedures generally provide written reconsideration and appeal rights, with 30-day periods tied to receipt of the applicable notice. Tribal program procedures may differ.\n\nA referral alone does not guarantee payment, but an authorized PRC claim should not be treated as an ordinary patient debt without examining the statutory nonliability protection.\n\n**Primary authorities:** 25 U.S.C. §§ 1621s–1621u; 42 CFR §§ 136.23–136.25; IHS Purchased/Referred Care program guidance.\n\n## 6. Hypothetical examples\n\nExample A — documented authorization. A qualifying patient receives $6,000 of outside specialist services specifically covered by an IHS PRC purchase order. The provider bills the patient $1,500 after processing another payer's benefits.\n\nAssuming the services were authorized and the billed charges are associated with those services, § 1621u(a) protects the patient from liability. The provider must pursue the applicable payment process rather than simply transfer the authorized-care balance to the patient.\n\nExample B — referral without payment authorization. An IHS clinician recommends a specialist. The patient receives $2,000 of treatment, but no PRC purchase order is documented and the program denies payment.\n\nThe referral does not establish authorization. The next question is whether the denial is correct under the applicable eligibility, notice, emergency and authorization rules. The patient's liability cannot be determined solely from the referral or the denial.\n\nExample C — emergency notification. A patient receives emergency treatment outside an IHS facility. The appropriate ordering official receives notification 48 hours after treatment begins.\n\nThat notification falls within the regulation's general 72-hour emergency-notification period. It does not, by itself, establish that all other eligibility and authorization conditions have been satisfied.\n\n## 7. Coverage and residual-gap table\n\n| Subtopic | Status | Claim/source IDs | Remaining evidence or action |\n| --- | --- | --- | --- |\n| Statutory patient nonliability | Answered | C039; S035 | Verify authorization for specific care |\n| Provider notification | Answered — statutory rule | C039; S035 § (b) | Actual claim receipt and notice |\n| Provider no-recourse protection | Answered — statutory rule | C039; S035 § (c) | Notice or deemed-acceptance facts |\n| Referral versus authorization | Answered | C039; PR8-S001, S003 | Actual authorization decision |\n| Purchase-order documentation | Answered — operational baseline | C039; PR8-S002, S006 | Specific order and service scope |\n| Emergency/nonemergency notice | Answered — regulatory baseline | C039; PR8-S002 | Actual dates and good-cause findings |\n| Eligibility and delivery area | Partial | C039; PR8-S001, S004 | Individual status and applicable PRCDA |\n| Medical priorities and funding | Partial | C039; PR8-S004 | Applicable program priorities and funds |\n| Alternate resources / payer coordination | Partial | C039; PR8-S001, S004 | Actual coverage and claim coordination |\n| Five-working-day claim-response mechanism | Partial | C039; PR8-S004; § 1621s | Full independent statutory/regulatory audit and complete claim facts |\n| Administrative appeal process | Answered — federal baseline | C039; PR8-S005 | Actual denial notice, receipt and program |\n| Tribal program differences | Held | C039; PR8-S004, S005 | Governing tribal agreement and procedures |\n| Current CFR amendment history | Partial | C039; PR8-S002, S005 | Compare current official codification |\n| Individual patient or provider liability | Unresolved — fact-specific | C039 | Authorization, claims, notices, payer records |\n\n## 8. Researcher self-check\n\nVerified directly: The current OLRC text of § 1621u(a)–(c), including the five-business-day notification and no-recourse provisions; IHS's published referral-versus-authorization explanation; § 136.24 authorization and notification language; the agency's appeal guidance; and relevant sections of the IHS Purchased/Referred Care Manual.\n\nNot fully verified: Current eCFR amendment history; every element of § 1621s deemed acceptance; individual eligibility or authorization; particular provider claims; tribal-program differences; and case-specific appeal deadlines.\n\nThis is a researcher self-check, not an independent review. The coordinator's unrelated EMTALA, hospital-transparency and tax-reporting evidence was not reexamined. No local files were saved, no publication occurred, and no external parties were contacted.\n\nFinal disposition: D012 PROGRAMS-08 resolves the core federal statutory source gap and supplies qualified operational support for C039. Individual authorization, payer coordination, tribal-program applicability and the identified regulatory details remain explicit holds. The other original D012 claims and the broader medical-debt area are not accepted by implication.\n\nEND D012 PROGRAMS-08\n\n","tables":[{"headers":[],"index":0,"links":[],"row_links":[[],[],[],[]],"rows":[["Pinpoint","Operative rule","Important qualification"],["§ 1621u(a)","A patient receiving IHS-authorized contract health care services is not liable for charges or costs associated with those services.","The protection attaches to qualifying authorized services, not every medical service received by an IHS patient."],["§ 1621u(b)","The Secretary must notify the contract-care provider and patient of the patient's nonliability within five business days after receiving the provider's claim notification.","This is a notification obligation triggered by receipt of a qualifying claim notification, not a universal five-day deadline for approving every referral."],["§ 1621u(c)","Following the statutory notice, or where a claim is deemed accepted under § 1621s(b), the provider has no further recourse against the patient.","The separate deemed-acceptance mechanism matters; authorization and claim acceptance should not be conflated."]]},{"headers":[],"index":1,"links":[],"row_links":[[],[],[],[],[],[],[],[],[]],"rows":[["Issue","Finding","Primary pinpoint"],["Referral versus authorization","A referral is a clinical recommendation, not a guarantee of payment. PRC must separately determine payment authorization.","IHS PRC FAQ, “An IHS doctor refers me to a specialist…” \nPurchased/Referred Care (PRC)"],["Authorization document","PRC ordinarily issues an IHS-843-1A Order for Health Services to authorize specific outside services.","IHS PRC Resources, “IHS-843-1A.” \nPurchased/Referred Care (PRC)"],["Nonemergency authorization","42 CFR § 136.24 generally requires advance notice and an appropriate purchase order. Limited exceptions permit later notification and waiver of advance notice.","IHS regulation reproduction, § 136.24(a)–(b). \nResources"],["Emergency notification","The regulation generally requires notification within 72 hours after emergency treatment begins or admission occurs, with extensions for impracticability or other good cause.","§ 136.24(c). \nResources"],["Eligibility","PRC eligibility depends on applicable tribal affiliation, residence or delivery-area rules, notification, medical priority and other requirements. PRC is not an entitlement program.","IHS Purchased/Referred Care for Patients. \nfor Patients"],["Other payers","PRC operates as a payer of last resort, requiring examination of available Medicare, Medicaid, private insurance and other alternate resources.","IHS PRC patient guidance and manual, including § 136.61 references. \nfor Patients\n+1"],["Claim-response rule","Under 25 U.S.C. § 1621s, IHS generally must respond to a qualifying provider claim notification with a purchase order or denial within five working days. The deemed-acceptance rule depends on a sufficiently complete qualifying claim.","IHS Manual, Part 2, Chapter 3, § 2-3.21. \nPart 2"],["Administrative appeals","Denials require written notice with reasons. Under 42 CFR § 136.25, reconsideration or appeal generally must be requested within 30 days after receipt of the applicable notice.","IHS PRC Appeal Process, § 136.25(a)–(c). \nPurchased/Referred Care (PRC)"]]},{"headers":[],"index":2,"links":[{"href":"https://uscode.house.gov/us/usc/119-120/t25/s1621u/?utm_source=chatgpt.com","text":"https://uscode.house.gov/us/usc/119-120/t25/s1621u/"},{"href":"https://www.ihs.gov/forpatients/prc/?utm_source=chatgpt.com","text":"https://www.ihs.gov/forpatients/prc/"},{"href":"https://www.ihs.gov/prc/resources/resources-regulations-136-24/?utm_source=chatgpt.com","text":"https://www.ihs.gov/prc/resources/resources-regulations-136-24/"},{"href":"https://www.ihs.gov/prc/frequently-asked-questions-faq-s/?utm_source=chatgpt.com","text":"https://www.ihs.gov/prc/frequently-asked-questions-faq-s/"},{"href":"https://www.ihs.gov/ihm/pc/part-2/chapter-3-purchased-referred-care/?utm_source=chatgpt.com","text":"https://www.ihs.gov/ihm/pc/part-2/chapter-3-purchased-referred-care/"},{"href":"https://www.ihs.gov/PRC/appeal-process/?utm_source=chatgpt.com","text":"https://www.ihs.gov/PRC/appeal-process/"},{"href":"https://www.ihs.gov/prc/resources/?utm_source=chatgpt.com","text":"https://www.ihs.gov/prc/resources/"}],"row_links":[[],[{"href":"https://uscode.house.gov/us/usc/119-120/t25/s1621u/?utm_source=chatgpt.com","text":"https://uscode.house.gov/us/usc/119-120/t25/s1621u/"}],[{"href":"https://www.ihs.gov/forpatients/prc/?utm_source=chatgpt.com","text":"https://www.ihs.gov/forpatients/prc/"}],[{"href":"https://www.ihs.gov/prc/resources/resources-regulations-136-24/?utm_source=chatgpt.com","text":"https://www.ihs.gov/prc/resources/resources-regulations-136-24/"}],[{"href":"https://www.ihs.gov/prc/frequently-asked-questions-faq-s/?utm_source=chatgpt.com","text":"https://www.ihs.gov/prc/frequently-asked-questions-faq-s/"}],[{"href":"https://www.ihs.gov/ihm/pc/part-2/chapter-3-purchased-referred-care/?utm_source=chatgpt.com","text":"https://www.ihs.gov/ihm/pc/part-2/chapter-3-purchased-referred-care/"}],[{"href":"https://www.ihs.gov/PRC/appeal-process/?utm_source=chatgpt.com","text":"https://www.ihs.gov/PRC/appeal-process/"}],[{"href":"https://www.ihs.gov/prc/resources/?utm_source=chatgpt.com","text":"https://www.ihs.gov/prc/resources/"}]],"rows":[["Source ID","Issuer, direct URL and pinpoint","Version, jurisdiction, access and limits"],["D012-S035","Congress/OLRC, 25 U.S.C. § 1621u — Liability for payment. https://uscode.house.gov/us/usc/119-120/t25/s1621u/ — subsections (a)–(c), 2010 amendment note and 2020 rule-of-construction note.","Opened/read. Current federal statute through Public Law 119-120 (Oct. 7, 2026). Original researcher access assertion not independently corroborated. \nuscode.house.gov"],["D012-PR8-S001","IHS, Purchased/Referred Care, patient overview. https://www.ihs.gov/forpatients/prc/ — paragraphs on referral, eligibility and alternate resources.","Opened/read. Current agency operational explanation; publication date not established. \nfor Patients"],["D012-PR8-S002","IHS, Resources: Regulations — 136.24. https://www.ihs.gov/prc/resources/resources-regulations-136-24/ — § 136.24(a)–(c).","Opened/read. Official agency reproduction of federal authorization regulation. Current eCFR amendment history not independently audited. \nResources"],["D012-PR8-S003","IHS, Frequently Asked Questions. https://www.ihs.gov/prc/frequently-asked-questions-faq-s/ — “An IHS doctor refers me to a specialist…” and alternate-resource questions.","Opened/read. Agency interpretation; referral is not payment authorization. \nPurchased/Referred Care (PRC)"],["D012-PR8-S004","IHS, Indian Health Manual, Part 2, Chapter 3, Purchased/Referred Care. https://www.ihs.gov/ihm/pc/part-2/chapter-3-purchased-referred-care/ — §§ 2-3.6, 2-3.8, 2-3.9, 2-3.11 and 2-3.21.","Opened/read relevant sections. Current published IHS operational manual; section-specific revision history not reconstructed. Includes explicit distinctions between federal IHS and tribal program procedures. \nPart 2"],["D012-PR8-S005","IHS, Appeal Process. https://www.ihs.gov/PRC/appeal-process/ — reproduced 42 CFR § 136.25(a)–(c).","Opened/read. Agency page reproduces a 2017 CFR edition; the page itself is not proof of every later regulatory amendment. Tribal procedures may differ. \nPurchased/Referred Care (PRC)"],["D012-PR8-S006","IHS, PRC Resources. https://www.ihs.gov/prc/resources/ — “IHS-843-1A, Order for Health Services” and regulatory resource index.","Opened/read. Agency explanation of purchase-order documentation and authorization. \nPurchased/Referred Care (PRC)"]]},{"headers":[],"index":3,"links":[],"row_links":[[],[],[],[],[],[],[],[],[],[],[],[]],"rows":[["Field","Corrected record"],["Claim ID","D012-C039 — preserved"],["Area","A016 / IHS / Purchased-Referred Care"],["Precise claim","Under 25 U.S.C. § 1621u(a), a patient who receives qualifying IHS-authorized contract health care services is not liable for charges or costs associated with those services. Section 1621u(b) requires notice to the provider and patient within five business days after the Secretary receives the specified provider claim notification. Under § 1621u(c), following that notice or statutory deemed acceptance under § 1621s(b), the provider has no further recourse against the patient."],["Authorization condition","A referral or clinical recommendation alone does not establish PRC payment authorization. The applicable eligibility, notification and authorization requirements must be satisfied; § 136.24 generally requires an appropriate purchase order."],["Eligibility conditions","Applicable tribal affiliation, residency or PRC delivery area, medical priority, notification, available funding and alternate-resource requirements."],["Payment distinction","The patient's statutory nonliability for authorized services is distinct from determining which payer reimburses the provider and in what amount."],["Appeal process","Denial and reconsideration procedures under 42 CFR § 136.25, including qualifying written notices and generally 30-day administrative appeal periods measured from receipt of the applicable notice."],["Primary sources","S035 § 1621u(a)–(c); PR8-S001–S006, particularly § 136.24(a)–(c), § 136.25(a)–(c), IHS Manual §§ 2-3.6, 2-3.8, 2-3.9, 2-3.11, 2-3.21."],["Jurisdiction/status","U.S. federal Indian health statute and IHS program requirements, checked October 22, 2026. Tribal program administration and individual eligibility require separate verification."],["Evidence limits","No individual purchase order, provider claim, denial, appeal, tribal program agreement or actual alternate-payer record examined. Current eCFR amendment audit incomplete."],["Disposition","Revised — controlling statutory rule verified; operational framework supported; individual authorization and tribal-program questions held."]]},{"headers":[],"index":4,"links":[],"row_links":[[],[],[],[],[],[],[],[],[],[],[],[],[],[],[]],"rows":[["Subtopic","Status","Claim/source IDs","Remaining evidence or action"],["Statutory patient nonliability","Answered","C039; S035","Verify authorization for specific care"],["Provider notification","Answered — statutory rule","C039; S035 § (b)","Actual claim receipt and notice"],["Provider no-recourse protection","Answered — statutory rule","C039; S035 § (c)","Notice or deemed-acceptance facts"],["Referral versus authorization","Answered","C039; PR8-S001, S003","Actual authorization decision"],["Purchase-order documentation","Answered — operational baseline","C039; PR8-S002, S006","Specific order and service scope"],["Emergency/nonemergency notice","Answered — regulatory baseline","C039; PR8-S002","Actual dates and good-cause findings"],["Eligibility and delivery area","Partial","C039; PR8-S001, S004","Individual status and applicable PRCDA"],["Medical priorities and funding","Partial","C039; PR8-S004","Applicable program priorities and funds"],["Alternate resources / payer coordination","Partial","C039; PR8-S001, S004","Actual coverage and claim coordination"],["Five-working-day claim-response mechanism","Partial","C039; PR8-S004; § 1621s","Full independent statutory/regulatory audit and complete claim facts"],["Administrative appeal process","Answered — federal baseline","C039; PR8-S005","Actual denial notice, receipt and program"],["Tribal program differences","Held","C039; PR8-S004, S005","Governing tribal agreement and procedures"],["Current CFR amendment history","Partial","C039; PR8-S002, S005","Compare current official codification"],["Individual patient or provider liability","Unresolved — fact-specific","C039","Authorization, claims, notices, payer records"]]}],"claims":[{"claim_id":"D012-C039","area_numbers":[16],"area_assignment_method":"explicit_report_label","researcher_record":{"Claim ID":"D012-C039 — preserved","Area":"A016 / IHS / Purchased-Referred Care","Precise claim":"Under 25 U.S.C. § 1621u(a), a patient who receives qualifying IHS-authorized contract health care services is not liable for charges or costs associated with those services. Section 1621u(b) requires notice to the provider and patient within five business days after the Secretary receives the specified provider claim notification. Under § 1621u(c), following that notice or statutory deemed acceptance under § 1621s(b), the provider has no further recourse against the patient.","Authorization condition":"A referral or clinical recommendation alone does not establish PRC payment authorization. The applicable eligibility, notification and authorization requirements must be satisfied; § 136.24 generally requires an appropriate purchase order.","Eligibility conditions":"Applicable tribal affiliation, residency or PRC delivery area, medical priority, notification, available funding and alternate-resource requirements.","Payment distinction":"The patient's statutory nonliability for authorized services is distinct from determining which payer reimburses the provider and in what amount.","Appeal process":"Denial and reconsideration procedures under 42 CFR § 136.25, including qualifying written notices and generally 30-day administrative appeal periods measured from receipt of the applicable notice.","Primary sources":"S035 § 1621u(a)–(c); PR8-S001–S006, particularly § 136.24(a)–(c), § 136.25(a)–(c), IHS Manual §§ 2-3.6, 2-3.8, 2-3.9, 2-3.11, 2-3.21.","Jurisdiction/status":"U.S. federal Indian health statute and IHS program requirements, checked October 22, 2026. Tribal program administration and individual eligibility require separate verification.","Evidence limits":"No individual purchase order, provider claim, denial, appeal, tribal program agreement or actual alternate-payer record examined. Current eCFR amendment audit incomplete.","Disposition":"Revised — controlling statutory rule verified; operational framework supported; individual authorization and tribal-program questions held."},"coordinator_verification_status":"scoped_primary_review_with_bounded_exception_and_receipt_correction_required","table_classification":"One complete vertical replacement claim; original ID preserved, no new claim identity.","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false}],"sources":[{"source_id":"D012-S035","urls":["https://uscode.house.gov/us/usc/119-120/t25/s1621u/","https://uscode.house.gov/us/usc/119-120/t25/s1621u/?utm_source=chatgpt.com"],"researcher_record":{"Source ID":"D012-S035","Issuer, direct URL and pinpoint":"Congress/OLRC, 25 U.S.C. § 1621u — Liability for payment. https://uscode.house.gov/us/usc/119-120/t25/s1621u/ — subsections (a)–(c), 2010 amendment note and 2020 rule-of-construction note.","Version, jurisdiction, access and limits":"Opened/read. Current federal statute through Public Law 119-120 (Oct. 7, 2026). Original researcher access assertion not independently corroborated. \nuscode.house.gov"},"coordinator_verification_status":"scoped_primary_review_with_bounded_exception_and_receipt_correction_required","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"source_id":"D012-PR8-S001","urls":["https://www.ihs.gov/forpatients/prc/","https://www.ihs.gov/forpatients/prc/?utm_source=chatgpt.com"],"researcher_record":{"Source ID":"D012-PR8-S001","Issuer, direct URL and pinpoint":"IHS, Purchased/Referred Care, patient overview. https://www.ihs.gov/forpatients/prc/ — paragraphs on referral, eligibility and alternate resources.","Version, jurisdiction, access and limits":"Opened/read. Current agency operational explanation; publication date not established. \nfor Patients"},"coordinator_verification_status":"scoped_primary_review_with_bounded_exception_and_receipt_correction_required","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"source_id":"D012-PR8-S002","urls":["https://www.ihs.gov/prc/resources/resources-regulations-136-24/","https://www.ihs.gov/prc/resources/resources-regulations-136-24/?utm_source=chatgpt.com"],"researcher_record":{"Source ID":"D012-PR8-S002","Issuer, direct URL and pinpoint":"IHS, Resources: Regulations — 136.24. https://www.ihs.gov/prc/resources/resources-regulations-136-24/ — § 136.24(a)–(c).","Version, jurisdiction, access and limits":"Opened/read. Official agency reproduction of federal authorization regulation. Current eCFR amendment history not independently audited. \nResources"},"coordinator_verification_status":"scoped_primary_review_with_bounded_exception_and_receipt_correction_required","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"source_id":"D012-PR8-S003","urls":["https://www.ihs.gov/prc/frequently-asked-questions-faq-s/","https://www.ihs.gov/prc/frequently-asked-questions-faq-s/?utm_source=chatgpt.com"],"researcher_record":{"Source ID":"D012-PR8-S003","Issuer, direct URL and pinpoint":"IHS, Frequently Asked Questions. https://www.ihs.gov/prc/frequently-asked-questions-faq-s/ — “An IHS doctor refers me to a specialist…” and alternate-resource questions.","Version, jurisdiction, access and limits":"Opened/read. Agency interpretation; referral is not payment authorization. \nPurchased/Referred Care (PRC)"},"coordinator_verification_status":"scoped_primary_review_with_bounded_exception_and_receipt_correction_required","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"source_id":"D012-PR8-S004","urls":["https://www.ihs.gov/ihm/pc/part-2/chapter-3-purchased-referred-care/","https://www.ihs.gov/ihm/pc/part-2/chapter-3-purchased-referred-care/?utm_source=chatgpt.com"],"researcher_record":{"Source ID":"D012-PR8-S004","Issuer, direct URL and pinpoint":"IHS, Indian Health Manual, Part 2, Chapter 3, Purchased/Referred Care. https://www.ihs.gov/ihm/pc/part-2/chapter-3-purchased-referred-care/ — §§ 2-3.6, 2-3.8, 2-3.9, 2-3.11 and 2-3.21.","Version, jurisdiction, access and limits":"Opened/read relevant sections. Current published IHS operational manual; section-specific revision history not reconstructed. Includes explicit distinctions between federal IHS and tribal program procedures. \nPart 2"},"coordinator_verification_status":"scoped_primary_review_with_bounded_exception_and_receipt_correction_required","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"source_id":"D012-PR8-S005","urls":["https://www.ihs.gov/PRC/appeal-process/","https://www.ihs.gov/PRC/appeal-process/?utm_source=chatgpt.com"],"researcher_record":{"Source ID":"D012-PR8-S005","Issuer, direct URL and pinpoint":"IHS, Appeal Process. https://www.ihs.gov/PRC/appeal-process/ — reproduced 42 CFR § 136.25(a)–(c).","Version, jurisdiction, access and limits":"Opened/read. Agency page reproduces a 2017 CFR edition; the page itself is not proof of every later regulatory amendment. Tribal procedures may differ. \nPurchased/Referred Care (PRC)"},"coordinator_verification_status":"scoped_primary_review_with_bounded_exception_and_receipt_correction_required","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"source_id":"D012-PR8-S006","urls":["https://www.ihs.gov/prc/resources/","https://www.ihs.gov/prc/resources/?utm_source=chatgpt.com"],"researcher_record":{"Source ID":"D012-PR8-S006","Issuer, direct URL and pinpoint":"IHS, PRC Resources. https://www.ihs.gov/prc/resources/ — “IHS-843-1A, Order for Health Services” and regulatory resource index.","Version, jurisdiction, access and limits":"Opened/read. Agency explanation of purchase-order documentation and authorization. \nPurchased/Referred Care (PRC)"},"coordinator_verification_status":"scoped_primary_review_with_bounded_exception_and_receipt_correction_required","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false}],"coverage":[{"topic":"Statutory patient nonliability","researcher_record":{"Subtopic":"Statutory patient nonliability","Status":"Answered","Claim/source IDs":"C039; S035","Remaining evidence or action":"Verify authorization for specific care"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Provider notification","researcher_record":{"Subtopic":"Provider notification","Status":"Answered — statutory rule","Claim/source IDs":"C039; S035 § (b)","Remaining evidence or action":"Actual claim receipt and notice"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Provider no-recourse protection","researcher_record":{"Subtopic":"Provider no-recourse protection","Status":"Answered — statutory rule","Claim/source IDs":"C039; S035 § (c)","Remaining evidence or action":"Notice or deemed-acceptance facts"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Referral versus authorization","researcher_record":{"Subtopic":"Referral versus authorization","Status":"Answered","Claim/source IDs":"C039; PR8-S001, S003","Remaining evidence or action":"Actual authorization decision"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Purchase-order documentation","researcher_record":{"Subtopic":"Purchase-order documentation","Status":"Answered — operational baseline","Claim/source IDs":"C039; PR8-S002, S006","Remaining evidence or action":"Specific order and service scope"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Emergency/nonemergency notice","researcher_record":{"Subtopic":"Emergency/nonemergency notice","Status":"Answered — regulatory baseline","Claim/source IDs":"C039; PR8-S002","Remaining evidence or action":"Actual dates and good-cause findings"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Eligibility and delivery area","researcher_record":{"Subtopic":"Eligibility and delivery area","Status":"Partial","Claim/source IDs":"C039; PR8-S001, S004","Remaining evidence or action":"Individual status and applicable PRCDA"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Medical priorities and funding","researcher_record":{"Subtopic":"Medical priorities and funding","Status":"Partial","Claim/source IDs":"C039; PR8-S004","Remaining evidence or action":"Applicable program priorities and funds"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Alternate resources / payer coordination","researcher_record":{"Subtopic":"Alternate resources / payer coordination","Status":"Partial","Claim/source IDs":"C039; PR8-S001, S004","Remaining evidence or action":"Actual coverage and claim coordination"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Five-working-day claim-response mechanism","researcher_record":{"Subtopic":"Five-working-day claim-response mechanism","Status":"Partial","Claim/source IDs":"C039; PR8-S004; § 1621s","Remaining evidence or action":"Full independent statutory/regulatory audit and complete claim facts"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Administrative appeal process","researcher_record":{"Subtopic":"Administrative appeal process","Status":"Answered — federal baseline","Claim/source IDs":"C039; PR8-S005","Remaining evidence or action":"Actual denial notice, receipt and program"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Tribal program differences","researcher_record":{"Subtopic":"Tribal program differences","Status":"Held","Claim/source IDs":"C039; PR8-S004, S005","Remaining evidence or action":"Governing tribal agreement and procedures"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Current CFR amendment history","researcher_record":{"Subtopic":"Current CFR amendment history","Status":"Partial","Claim/source IDs":"C039; PR8-S002, S005","Remaining evidence or action":"Compare current official codification"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false},{"topic":"Individual patient or provider liability","researcher_record":{"Subtopic":"Individual patient or provider liability","Status":"Unresolved — fact-specific","Claim/source IDs":"C039","Remaining evidence or action":"Authorization, claims, notices, payer records"},"coordinator_acceptance":"scoped_review_required_exception_and_receipt_correction","coordinator_review":"[internal evidence reference]","parent_assignment_complete":false}],"annotations":{},"corrections":[],"resolved_corrections":[],"review_history":[]}