Patient Records - Health Information Management (HIM) (2023)

Table of Contents
AMERICAN NATIVES NATURAL CHILDREN Adopted, step and foster children NON-ELIGIBLE SPOUSES NON-ELIGIBLE SPOUSE PREGNANT WITH AN ELIGIBLE CHILD NON-ELIGIBLE EMERGENCY CARE NON-ELIGIBLE EMPLOYEES (SEE NON-ELIGIBLE EMPLOYEE POLICY IN PERSONNEL SECTION) NON-INDIAN MEMBERS ON ACTIVE EMPLOYMENT IN THE ARMED FORCES, INCLUDING SPOUSES AND DEPENDENTS – THIS INCLUDES COMMISSIONED CORP. ACUTE INFECTIOUS DISEASE SPECIAL SERVICES NON-SPECIALIST SERVICES Videos

Revised April 2016 with updates February 2020, July 2020, November 2020, April 2021, April 2022. The Choctaw Nation Health Services Authority (CNHSA) will provide healthcare services at the Choctaw Nation Health Care Center, Talihina, and all field clinics in accordance with the following guidelines:

  1. AMERICAN NATIVES

    A Native American with a CDIB card, membership card, or progeny letter from a federally recognized tribe is eligible for services as described in the policies below. Social security card required. From the age of 18, a photo ID is also required.

    Please note: To be eligible for Choctaw Referred Care, the patient must provide proof of residency in Atoka, Choctaw, Haskell, Latimer, Leflore, McCurtain, Pittsburg, Pushmataha, or Bryan counties in Oklahoma. The length of stay must be at least 180 days. Proof of residency consists of the following: tax returns, Oklahoma driver's license, vehicle registrations, utility bills, bank statements, school registration, and physical address (no PO Box). The burden of proof lies with the patient.

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  2. NATURAL CHILDREN

    Biological children under the age of 19 of an eligible parent are eligible. If a child has their own CDIB, a state birth certificate and social security card are required. (required from the first year of life)

    If a child does not have their own CDIB, eligibility is determined only by the parent. A copy of the parents' CDIB, state birth certificate and social security card are required. (Required from age 1) Grandparents, other relatives or friends can verify the child's eligibility by providing the above documents in addition to a letter from a parent authorizing the child's medical care. In certain cases, as determined by the Administrator, due diligence may be performed without the production of a CDIB. Individuals are required to provide documentation prior to their next visit. In the event of non-compliance, the services rendered will be invoiced and further care will be excluded.

  3. Adopted, step and foster children

    An adopted child, stepchild, foster child, legal ward, or orphan under the age of 19 of an Eligible Parent is eligible for benefits other than the Diabetes Wellness Center. A stepchild must live in the native's home, and recertification is required once a year. The following documents must be submitted as proof of eligibility.
    1. Parents' marriage certificate
    2. child's birth certificate
    3. CDIB, membership card or progeny letter from the eligible parent
    4. Proof of Dependency (eg, divorce papers, tax forms, adoption papers, custody agreement, court orders, affidavit for a minor child) Note: School records may show the address where the child lives
    5. Eligible Parents MUST complete an Affidavit of Dependence Acknowledgment of Dependency once a year. (Stepchild) (notarized if signed off-site)
    6. The Choctaw Nation Board of Health does not recognize common law marriages. Stepchildren from these circumstances are not entitled to childcare.

  4. NON-ELIGIBLE SPOUSES

    Ineligible spouses are entitled to limited fee-based services. (With insurance) (Must have a third-party payer.) Ineligible spouses may only use laboratory services, radiology, surgical clinic, women's clinic, family doctor's office, emergency/emergency care, and inpatient services. Ineligible spouses can only be seen at Talihina Hospital.

    Ineligible spouses are responsible for deductibles and paying the balance after the third (3rd) payer has been billed.

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    The following documents must be submitted to determine eligibility:

    1. marriage certificate
    2. CDIB, membership card or letter of progeny from eligible spouse
    3. Proof of insurance: Medicare, Medicaid, or private insurance card
    4. Current photo ID
    5. In the event of the death of the eligible spouse, benefits continue until the ineligible spouse remarries
    6. Ineligible spouses can only be seen at the Choctaw Nation Health Center in Talihina.

  5. NON-ELIGIBLE SPOUSE PREGNANT WITH AN ELIGIBLE CHILD

    Ineligible spouse who is pregnant with an eligible child: ALL pregnancy-related services. (To be determined by the doctor). The following documents must be submitted to determine eligibility:
    1. marriage certificate
    2. CDIB, Membership Card or Progeny Letter
    3. Proof of pregnancy (positive test from the health department)
    4. Current photo ID

    Please note: If individuals are not married, paternity papers must be completed at the first antenatal visit to the hospital. The authorized person must be present for the signature. Individuals must provide photo ID with signature. This includes all forms of paternity such as denial of paternity.

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    Ineligible spouses are ONLY entitled to Talihina Hospital services (except for prescriptions related to pregnancy, which are determined by the physician and are available at any outpatient clinic) until cleared by the provider. The patient will be evaluated for medical care related to the pregnancy up to six weeks after delivery. If the condition persists after pregnancy, care may be established with an outside provider.

    Note:
    If a stepchild and/or an ineligible dependent is pregnant, the patient is entitled to all pregnancy-related benefits for up to six weeks after the birth.

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    After a stepchild and/or an ineligible dependent gives birth, that person is emancipated. (Emancipated is considered adult.)

    Stepchild and/or non-eligible dependent (mother) child born at Choctaw Nation Health Care Center will be cared for for six weeks after birth.

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  6. NON-ELIGIBLE EMERGENCY CARE

    CNHCC will assess/treat any emergency involving potential loss of life or limb (CNHCC complies with all laws governing emergency medical services). Ineligible patients who present with a non-occurring symptom are evaluated to determine the need for treatment. (Before transfer to another facility, an attempt is made to stabilize the patient.) In cases of doubt, the on-call service decides on admission. These people must pay for the Episode of Care.

    Medication will not be dispensed. If Provider determines a medical need and no alternative source of procurement of medication is available, Provider may provide a one-time (1) dose or a daily dose to begin initial treatment.

  7. NON-ELIGIBLE EMPLOYEES (SEE NON-ELIGIBLE EMPLOYEE POLICY IN PERSONNEL SECTION)

  8. NON-INDIAN MEMBERS ON ACTIVE EMPLOYMENT IN THE ARMED FORCES, INCLUDING SPOUSES AND DEPENDENTS – THIS INCLUDES COMMISSIONED CORP.

    Active non-Indian members of the Armed Forces are entitled to all services except Diabetes Wellness Center, Choctaw Referred Care and Pharmacy for a fee.

    Ineligible spouses and dependents (under the age of 18) of non-Indian Active Duty Armed Forces personnel are entitled to laboratory, radiology, emergency or emergency care only for a fee. Talihina only

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  9. ACUTE INFECTIOUS DISEASE

    Non-Indian family members residing in the home of a beneficiary who has been diagnosed with an acute infectious disease will be screened/treated for the disease.

  10. SPECIAL SERVICES

    All patients treated by in-house specialty services must meet the following guidelines:
    1. BIOLOGICAL MEDICATIONS 3 year resident – ​​Restricted to CRC/Choctaw (living in 10 ½ counties) for a minimum of three (3) years.
    2. CARDIOLOGY-18 years+; Echo 18+; Holter Monitor 18+- Restricted to CRC only (any tribe living in 9 counties) Restricted to CRC/Choctaw (living in 10 ½ counties) for a minimum of three (3) years.
    3. DENTAL PEDIATRIC <8 years - Restricted to CRC/Choctaw (living in 10½ counties) for at least 3 years. Children must be 8 years old and younger.
    4. DERMATOLOGY – CDIB holder, direct (any tribe living anywhere) Any patient with consultation and ineligible spouse with third-party payer.
    5. EEG – Limited to CRC/Choctaw only (lives in 10 ½ counties) ordered by neurologist.
    6. Endocrinology - CDIB holders, direct (any tribe living anywhere), including pediatrics and FNA.
    7. Endodontics > 14 years - restricted to CRC/Choctaw only (lives in 10 ½ counties)
    8. ENT Talihina (inc surgery) 2 years+- Restricted to CRC only (Any tribe living in 9 counties) Restricted to CRC/Choctaw only (Living in 10 ½ counties)
    9. ENT Durant CDIB holder, direct (Any tribe living anywhere
    10. GASTROINTESTINAL – CDIB Holder, Direct (Any tribe living anywhere) Limited to CRC only (Any tribe living in 9 counties) Limited to CRC/Choctaw only (Living in 10 ½ counties)
    11. NEUROLOGY – Restricted to CRC/Choctaw Only (lives in 10 ½ counties), sees patients 2 years and older. (For migraines, two (2) therapies must have failed. Will look for other serious neurological problems).
    12. OPHTHALMOLOGY CATARACT SERVICES – Limited to CRC/Choctaw (lives in 10 ½ counties) Exception: IN-HOUSE cataract surgery only, NOT CRC
      • Must be Choctaw
      • CDIB must have been issued in Oklahoma. This includes the Mississippi Ribbon as long as it is issued in OK.
      • You don't have to live in the counties.
      • May or Mai has no third party.
      • May also qualify for cataract surgery regardless of tribe if performed by Dr. Fransen (Retina Clinic) is being treated and he needs an extraction to continue his treatment/care.
    13. ORTHO MID-LEVEL – Limited to CRC only (Any tribe living in 9 counties)
    14. ORTHOPEDIC SURGEON - Restricted to CRC/Choctaw (lives in 10 ½ counties) may be Mississippi Choctaw if Oklahoma CDIB.
    15. PT-EMG/NCVS - restricted to CRC/Choctaw only (living in 10 ½ counties)
    16. PULMONAL 16 years and older - Restricted to CRC only (any tribe living in 9 counties), Restricted to CRC/Choctaw only (living in 10 ½ counties)
    17. RHEUMATOLOGY - Durant > 18 only - Limited to CRC/Choctaw only (living in 10 ½ counties) No patients under 18 years of age.
    18. SLEEP LAB – Limited to CRC/Choctaw only (living in 10 ½ counties) Age 15 and older is non-diabetic and age 10-15 must be diabetic.

  11. NON-SPECIALIST SERVICES

    1. 24 hour event monitors - CDIB holders, direct (any tribe living anywhere)
    2. 30-day event monitoring - limited to CRC only (any tribe living in 9 districts)
    3. ACC-CDIB holder, direct (any tribe living anywhere)
    4. Audiology Hearing Test/Examination) - CDIB holder, direct (Every tribe living anywhere
    5. Audiology hearing aids/batteries - limited to CRC/Choctaw only (living in 10 ½ counties)
    6. Behavioral Health – CDIB holders, direct (any tribe living anywhere), ineligible pregnant women with an eligible child up to 6 weeks. after childbirth (due to pregnancy) Only crisis, only Talihina. Disabled Health Care Worker & Omission Corp. (Bariatric) with insurance.
    7. Chi Hullo Li (female) - CDIB holder, direct (any tribe living anywhere)
    8. Choctaw Referred Care (CRC) - Restricted to CRC only (Every tribe living in 9 counties)
    9. Community Health Nurse - CDIB holder, direct (any tribe living anywhere) (Imm). Limited to CRC only (Any tribe living in 9 counties) (NB)
    10. Dental - CDIB holders, direct (any tribe living anywhere)
    11. De-Sat monitors - CDIB holders, direct (any tribe living anywhere)
    12. Diabetic Educators - CDIB holders, direct (every tribe living anywhere)
    13. Dietitian - CDIB holder, direct (any tribe living anywhere)
    14. DWC - CDIB holder, direct (any tribe living anywhere)
    15. Emergency/Urgent Care – CDIB holders, direct (any tribe living anywhere), restricted to CRC only (every tribe living in 9 counties), restricted to CRC/Choctaw only (living in 10 ½ counties), non-eligible Pregnant women with an entitled person Child up to 6 weeks. after childbirth (due to pregnancy, Talihina only), non-eligible spouse with insurance Talihina only, . Ineligible Healthcare Workers & Omission Corp. with insurance, non-eligible health care workers spouses and dependent children with insurance.
    16. Employee Health (All Employees) Spouses and Children – Spouses and dependent children of non-eligible healthcare workers, ALL CNO employees. Insurance not required.
    17. Eye Clinic (including Retina) - CDIB holders, direct (any tribe living anywhere)
    18. Family Practice - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living within 9 counties), Limited to CRC/Choctaw only (Living within 10 ½ counties), Not eligible Pregnant with eligible child up to 6 weeks . after childbirth (due to pregnancy, Talihina only), non-eligible spouse with insurance Talihina only, . Ineligible Healthcare Workers & Omission Corp. with insurance, non-eligible health care workers spouses and dependent children with insurance.
    19. Imaging (excluding MRI) - Direct (any tribe living anywhere), restricted to CRC only (any tribe living in 9 counties), restricted to CRC/Choctaw only (living in 10 ½ counties), ineligible Pregnant with any entitled child up to 6 weeks Postpartum (Due to Pregnancy, Talihina Only), Ineligible Spouse with Insurance Talihina Only, Ineligible Health Care Worker & Commission Corp. with insurance, ineligible spouse in health care and dependent children with insurance.
    20. Inpatient Services - Direct (any tribe living anywhere), limited to CRC only (any tribe living in 9 counties), limited to CRC/Choctaw only (living in 10 ½ counties), not eligible Pregnant with an eligible child up to to 6 weeks. after childbirth (due to pregnancy, Talihina only), non-eligible spouse with insurance Talihina only, . Ineligible Healthcare Workers & Omission Corp. with insurance, non-eligible health care workers spouses and dependent children with insurance.
    21. Labor – Direct (any tribe living anywhere), limited to CRC only (any tribe living in 9 counties), limited to CRC/Choctaw only (living in 10 ½ counties), not eligible Pregnant with an eligible child up to 6 weeks. Postpartum (Due to Pregnancy, Talihina Only), Ineligible Spouse with Insurance Talihina Only, Ineligible Health Care Worker & Omission Corp. with insurance, unauthorized healthcare worker and dependent children with insurance.
    22. MRT - CDIB holders, direct (any tribe living anywhere), unauthorized healthcare workers and Commission Corp. with insurance, unauthorized healthcare workers, spouse and dependent children with insurance.
    23. Nutritional Therapy Counseling - CDIB holders, direct (every tribe living anywhere). Disabled Health Care Worker & Omission Corp. (Bariatric) with insurance.
    24. Nutritional Therapy Supplement - Limited to CRC only (Any tribe living in 9 districts
    25. OB - Direct (Any tribe living anywhere), Restricted to CRC (Any tribe living in 9 counties), Restricted to CRC/Choctaw Only (living in 10 ½ counties), Not eligible Pregnant with eligible child up to 6 weeks. after childbirth (due to pregnancy, Talihina only), non-eligible spouse with insurance Talihina only, . Ineligible Healthcare Workers & Omission Corp. with insurance, non-eligible health care workers spouses and dependent children with insurance.
    26. OMT (Osteopathic Manipulation Therapy) - CDIB holders, direct (any tribe living anywhere)
    27. Ophthalmology-Retinal - CDIB holder, direct (any tribe living anywhere)
    28. OR - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living within 9 counties), Limited to CRC/Choctaw only (Living within 10 ½ counties), Not Qualified Pregnant with qualifying child up to 6 weeks. Postpartum (Due to Pregnancy, Talihina Only), Ineligible Spouse with Insurance Talihina Only, Ineligible Health Care Worker & Omission Corp. with insurance, unauthorized healthcare worker and dependent children with insurance.
    29. OT - CDIB holder, direct (any tribe living anywhere)
    30. Pediatrics – Direct (any tribe living anywhere), restricted to CRC only (any tribe living in 9 counties), restricted to CRC/Choctaw only (living in 10 ½ counties), ineligible pregnant with an eligible child up to 6 weeks. Postpartum (Due to Pregnancy, Talihina Only), Ineligible Spouse with Insurance Talihina Only, Ineligible Health Care Worker & Omission Corp. with insurance, unauthorized healthcare worker and dependent children with insurance.
    31. Pharmacy - CDIB holder, direct (any tribe living anywhere), not eligible Pregnant with an eligible child up to 6 weeks. after childbirth (pregnancy-related, only Talihina)
    32. Physiotherapy – CDIB holders, direct (any tribe living anywhere), ineligible pregnant women with an eligible child up to 6 weeks. postpartum (pregnancy-related, Talihina only, breast program), non-eligible spouse with Talihina only insurance, non-eligible health care worker & Omission Corp. with insurance, non-eligible spouse in health care and dependent children with insurance. Talihina only.
    33. Podiatry - All Ages - CDIB Holders, Direct (Every tribe that lives anywhere)
    34. Recreation Center - (male) - CDIB holder, direct (any tribe living anywhere)
    35. Respiratory Therapy - Direct (any tribe living anywhere), restricted to CRC only (any tribe living in 9 counties), restricted to CRC/Choctaw only (living in 10 ½ counties), ineligible pregnant with an eligible child up to 6 weeks . Postpartum (Due to Pregnancy, Talihina Only), Ineligible Spouse with Insurance Talihina Only, Ineligible Health Care Worker & Omission Corp. with insurance, unauthorized healthcare worker and dependent children with insurance.
    36. Community Service - Direct (any tribe living anywhere), limited to CRC only (any tribe living in 9 counties), limited to CRC/Choctaw only (living in 10 ½ counties), not eligible Pregnant with eligible child up to 6 weeks . Postpartum (Due to Pregnancy, Talihina Only), Ineligible Spouse with Insurance Talihina Only, Ineligible Health Care Worker & Omission Corp. with insurance, unauthorized healthcare worker and dependent children with insurance.
    37. Special Transport - CDIB Holders, Direct (Any Tribe Living Anywhere)
    38. Speech Therapy - CDIB Holders, Direct (Any Tribe Living Anywhere)
    39. Surgery - Direct (any tribe living anywhere), restricted to CRC only (any tribe living in 9 counties), restricted to CRC/Choctaw only (living in 10 ½ counties), ineligible pregnant with an eligible child up to 6 weeks. Postpartum (Due to Pregnancy, Talihina Only), Ineligible Spouse with Insurance Talihina Only, Ineligible Health Care Worker & Omission Corp. with insurance, unauthorized healthcare worker and dependent children with insurance.
    40. Talihina Community Clinic – Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw only (Living in 10 ½ counties), Not eligible Pregnant with an eligible child up to 6 years weeks. Postpartum (Due to Pregnancy, Talihina Only), Ineligible Spouse with Insurance Talihina Only, Ineligible Health Care Worker & Omission Corp. with insurance, unauthorized healthcare worker and dependent children with insurance.
    41. Women's Health - Direct (any tribe living anywhere), restricted to CRC only (any tribe living in 9 counties), restricted to CRC/Choctaw only (living in 10 ½ counties), ineligible pregnant with an eligible child up to 6 weeks . Postpartum (Due to Pregnancy, Talihina Only), Ineligible Spouse with Insurance Talihina Only, Ineligible Health Care Worker & Omission Corp. with insurance, unauthorized healthcare worker and dependent children with insurance.

Please note: the conditions of participation change frequently. As the policy is updated, a cover sheet of changes will be presented to leadership, senior medical staff and the board of directors. Annually, the admission guidelines are submitted to these respective committees for approval.

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