The following information is not a complete listing of all Contract Health Services guidelines or other requirements. However, in general CHS supports care provided through our clinic.

• A health insurance program
• An entitlement program

• For services our clinic could have reasonably provided.
• If you are eligible, or would have been eligible if you had applied, for alternate resources, such as health/medical insurance, state, Medicaid, federal, or other assistance programs.
• If you choose to go to providers who do not accept your insurance or are otherwise out of the network of your insurance coverage, PPO, HMO or MCO.

Your CHS request must fall within the Band’s and federal IHS health priority categories and be medically necessary to be considered for payment. Non-emergent use of emergency room services does not meet medical necessity standards and will not be paid by CHS. Emergency situations are those health situations that are life- or limb-threatening and include heart attacks, active labor and delivery, excessive and unstoppable bleeding and treatment for sudden, extensive physical trauma. After-hours medical treatment for non-emergency reasons such as anxiety, flu, earache or headache are not appropriately treated in the emergency room and will not be paid by CHS.

1. Be an enrolled member of the Pokagon Band of Potawatomi Indians (this includes infants).
2. Reside within the Band’s 10-county Contract Health Services Delivery Area (CHSDA). Our CHSDA counties are Allegan, Berrien, Cass and Van Buren in Michigan and Elkhart, Kosciusko, LaPorte, Marshall, Starke and St. Joseph in Indiana.
3. Establish and maintain a complete registration file for CHS. You must update your file at least annually and whenever any of your registration information changes.
4. Keep your registration file current by providing documentation about any changes in your address, name, medical insurances or other types of health care coverage including state, Medicaid, or Medicare, and other pertinent registration information.

You must properly notify our CHS program staff at least three days before receiving non-emergency services (usually by phone conversation with CHS staff person). This includes all follow-up appointments including labs, surgeries, and any and all dental procedures beyond the initial exam. CHS cannot pay unless you have notified our office that you have been referred outside our clinic.

In cases of medical emergency, you must notify our CHS staff within 72 hours of the start of emergency care. Elders or disabled people have 30 days to notify our CHS staff of emergency care.

• Provider billing claim statements: these are HCFA 1500, UB 92, and/ or other claims that have the diagnostic and procedural coding written on them.
• All pertinent Explanations of Benefit (EOB). The EOB is issued from your other payers or insurance. The EOB explains what has been paid and the unpaid balance.

CHS is limited by the budget and medical priorities. If you have any questions, call us. We have staff who are trained to help you use this program. (269)782-4141 or 1-888-440-1234.