Referral Process

When services are not available at Creek Nation clinics and/or hospital or at an IHS facility where the patient regularly receives care, a physician will initiate a referral to a contract specialty provider.

Referral Steps

• Nurse/ Provider will direct you to the CHS Coordinator's office and your chart and referral will be taken to CHS office.
• CHS Coordinators will counsel you regarding eligibility, alternate resources such as Medicare, Medicaid, private insurance, VA, Worker's Comp, and Sooner Care.
• If you have no other resource, a screening will be done to see if you meet the criteria to apply for Medical Assistance program through the Department of Human Services (DHS).
• In emergency referral, a letter will be sent to you to make this Medical Assistance application through the DHS program.
• Patient will need another referral from his/ her doctor for  additional procedures, tests, follow-up exams, and/ or hospitalization.
• If patient schedules or reschedules an appointment without proper CHS authorization, the patient will be responsible for payment.
• Get to know your CHS Coordinators at the clinic you normally use to help with any schedules and questions regarding Contract Health Services.

Review Committee

CHS Coordinator at each clinic prepares all referrals to submit weekly for the CHS Review Committee.

• The Review Committee meets weekly and reviews an average of 70 requisitions.
• Referrals from all clinics are reviewed and categorized in accordance with approved CHS medical priorities.
• Individual referrals are prioritized with a medical priority and are then ranked within the priority.

Funding Process

Funds approval is based on weekly allocation and applied to the referrals in the order they have been prioritized and ranked.

Deferred Referrals

Deferred referrals are defined as service requested and meets medical priority, but no funds are available to pay for them.

Deferred referrals will be resubmitted for review up to three consecutive weeks for further consideration for payment of services and prioritized and ranked with new referrals presented at those meetings.

Denied Referrals

Denial of payment for referrals could be for different reasons:

• Service for which you requested is not within medical priority and funding range.

• No prior approval for non-emergency services.

• Eligibility not established by providing Certificate of Degree of Indian Blood (CDIB).

• Failure to use alternate resources such as Medicare, Medicaid, VA, Motor Vehicle Insurance, Worker's Comp, other group health insurance, and failure to apply for Medical Assistance Program (DHS) or not cooperating to provide necessary documentation.

• Persons who reside outside the state are not eligible for CHS.

CHS Central Office Staff will notify each patient in writing of the action to deny his/ her referral.  Copies of the denial letter are mailed to the patient's MCN provider who initiated the referral and to an outside provider if they had provided the services.

You can appeal for denied services.

- William James

Please do not hesitate to contact us at the numbers below with any questions you may have regarding the services offered by the Health System or eligibility requirements for those services.

(918)756-4333

(800)782-8291 

We welcome any feedback you may have regarding this site.