PRC & MLR Strategy
Purchase Referred Care represents one of the most financially sensitive components of Tribal health operations. THA's team of subject matter experts comes alongside your leadership — providing the strategy, oversight, and financial protection your Nation needs to preserve limited PRC funds and ensure long-term program sustainability.
Protecting Your Future — one claim at a time.
Your Future
Sustainable health systems don't happen by accident. THA guides Tribal Nations through the transitions, assumptions, and infrastructure decisions that protect access to care for future generations.
See how we support Tribal futures. ↓
Your Programs
Strong programs require strong operations. THA works alongside Tribal leadership to optimize financial performance, strengthen clinical operations, and ensure every program delivers maximum value to your community.
Your People
Healthy communities begin with accessible, high-quality care. THA helps Tribal Nations strengthen the programs, services, and systems that keep your people well — today and for generations to come.
Here's how we can help.
PRC Program Assessment & Gap Analysis
Evaluate your current PRC operations against federal requirements — identifying staffing gaps, workflow inefficiencies, policy deficiencies, and missed revenue opportunities before they become larger problems.
PRC Policies, Procedures & SOPs
Develop or update PRC policies and procedures aligned with current federal requirements — replacing outdated practices with standardized, audit-ready workflows your team can implement and sustain.
MLR Strategy & Administration
Many Tribal programs leave significant PRC savings on the table through incomplete or inaccurate Medicare-Like Rate application. THA helps Tribal leaders evaluate their current MLR approach and connects them with a vetted MLR partner whose proprietary methodology uses real-time Medicare fee schedules — not CMS estimates — consistently delivering 10-20% additional savings.
Medical Priority Level Strategy
Optimize MPL utilization, address procedure backlogs, and identify supplemental coverage opportunities — ensuring your PRC resources are allocated effectively and your community receives timely, appropriate care.
TSHIP & Supplemental Coverage Strategy
Tribally Self-funded Health Insurance Plans (TSHIP) and other supplemental coverage options can significantly extend PRC resources — covering beneficiaries when they travel, reducing PRC expenditures, and expanding care options for community members at no cost to them. THA helps Tribal Nations evaluate, implement, and optimize TSHIP and related supplemental coverage strategies to strengthen overall PRC sustainability
Third-Party Revenue Coordination
Identify and maximize third-party revenue streams — including Medicare, Medicaid, and private insurance — to offset PRC expenditures, strengthen program sustainability, and ensure every available funding source is working for your community.
For comprehensive Revenue Cycle support including day-to-day PRC administration and claims management, see our Revenue Cycle page →
Financial Oversight & Sustainability Planning
Reconcile PRC expenditures, monitor third-party revenue, manage high-cost referrals, and develop reporting tools that give Tribal leadership clear, actionable financial insight into PRC program performance and long-term sustainability.
PRC Transition & Assumption Support
Assuming PRC operations from IHS is a significant undertaking. THA guides Tribal Nations through staffing alignment, process mapping, financial oversight, and operational readiness — ensuring uninterrupted care during transition and sustainable operations from day one.
Understanding PRC & Medicare-Like Rates
Purchased/Referred Care (PRC) funds healthcare services that Tribal health programs cannot provide directly — covering referrals to specialists, hospitals, and other providers. Because PRC budgets are limited and demand is high, careful management is essential. PRC was formerly called Contract Health Services (CHS).
Medicare-Like Rates (MLR) are the maximum amounts providers can charge for services delivered to PRC patients. When applied accurately and consistently, MLR can significantly reduce PRC expenditures — preserving limited funds and extending care access for your community.
The difference between proper and improper MLR application can reach hundreds of thousands of dollars annually. THA helps Tribal Nations ensure every dollar of PRC funding works as hard as possible.
Explore Related THA Services:
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Revenue Cycle Management — day-to-day PRC administration and claims support
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Staff Development & Capacity Building — PRC staff training and capacity building
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Health System Strengthening — compliance program development and audit readiness
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Assumptions & Expansion — assuming PRC operations from IHS
Operations. Transitions. Outcomes.
Executive guidance and hands-on support for Tribal and Urban Indian health systems.