Member Services – (formerly PRC)

The Paiute Indian Tribe of Utah and FourPoints Health now have a dedicated Member Services Team that offers insurance enrollment assistance, and prior authorization referral care services (formerly PRC) for qualifying Tribal Members and their families.

If you are new to this service, please take a moment to review eligibility criteria and information below.

You can contact the team via the chat/help app in the lower right, or call: 435.201.5747

Office Hours: Monday – Friday, 8:00 am – 5:00 pm Mountain Time.

**If you require after hours assistance, please select option 3 for the on-call provider when prompted**

If you have received a bill for an authorized service, please upload it below.

Upload a bill here.

APPEAL PROCESS FOR DENIED SERVICES

If you believe you have received a bill for a denied service and feel it should be covered, please submit a claims appeal by filling out the form below.

For questions on the appeals process, please call: Rosa Lopez, 435.586.1112 ext. 3510

Submit an appeal here.
ELIGIBILITY Requirements:
PITU Member Living in PITU Service Area

Documentation required:

  • Membership verification.
  • Proof of residency. Must live within Iron, Millard, Sevier or Washington Counties.
PITU Member Away at School

Documentation required:

  • Proof of tribal enrollment (CIB, Tribal ID).
  • Proof of full-time school enrollment (official school document). 
Pregnancy Eligibility

Documentation required:

  • Proof of pregnancy from FourPoints Health clinic.  
  • Proof of eligible father’s PITU tribal enrollment (CIB, Tribal ID).  
  • Proof of PRC eligibility for father. 
Married to a PITU Member Living in PITU Service Area

Documentation required:

  • Marriage Certificate (Must be legally married). 
  • Proof of PRC eligibility for spouse. 
Child Eligibility

Documentation required:

  • Proof of parent PRC eligibility.  
  • Only eligible until 19th birthday.
  • Proof of legal guardianship.  

 

PITU Member Moving Outside of PITU Service Area

Documentation required:

  • PRC Eligible for 180 days after moving outside of PITU Service Area.
  • Proof of PRC eligibilty during residence within PITU Service Area.
PITU Member Moving Back into PITU Service Area

Documentation required:

  • Proof of residence within PRCDA (qualified service area) for at least 90 days (Utility bill, rent agreement, tax records).
PITU Foster Child Living Outside of PITU Service Area

Documentation required:

  • Proof of tribal enrollment (CIB, Tribal ID).
  • Proof of living in service area when placed in care.
  • Proof of legal guardianship for Foster Care.
    Member of a Federally Recognized Tribe Living on PITU Reservation Lands

    Documentation required:

    • Proof of tribal enrollment (CIB, Tribal ID).
    • Proof of address (Utility Bill, Rental Agreement, Notarized letter stating member is living with said person.
    Non-Native with Communicable Disease Living in Eligible PITU Member Household

    Documentation required:

    • Proof of disease.
    • Proof of residency.
    Native Member of another Federally Recognized Tribe who Works for the Tribe

    Documentation required:

    • Proof of tribal enrollment (CIB, Tribal ID).
    • Proof of employment for the Tribe.