What is Prime Health?
Prime Health Services is a national medical management company
that offers our services to the Workers' Compensation, Group
Health, Auto, Corrections, and Medicare industries.
What types of services does Prime Health offer to insurance
companies, TPAs, and self-insureds?
Prime Health offers a full spectrum of services including our
nationwide PPO Network, PBM Services, Bill Review, Case Management,
and a provider outcomes based program Prime Metrics. Please see our
Services tab for detail information on each program.
Is Prime Health an insurance company?
No, Prime Health is not an insurance company. We are a national
Preferred Provider Network. We are one of the fastest growing PPOs
in the country and have been serving the insurance industry since
Is Prime Health a silent PPO Network?
No, Prime Health is an advocate against silent PPOs. We require
that all EORs/EOBs indicate Prime Health Services as well as any
discounts taken according to supported contracts
What repricing methods does Prime Health offer to your
Prime Health offers a real-time XML Soap EDI Bridge, which
reprices bills within 0.25 seconds, 837 format, as well as any of
our client's proprietary EDI connections. We work to ensure
implementation is a smooth process and accommodates our client's
How long does it take to reprice a bill/claim?
Prime Health's real-time EDI Bridge takes 0.25 seconds to
reprice a bill/claim.
Who would I contact if we would like to begin accessing the Prime
To obtain additional information on the Prime Health Network,
please contact at Prime Health's Sales Executive at
How do I nominate a provider to become in network?
Please visit our Provider Nominations page or contact your
How do I locate a Prime Health provider?
The best way to locate a provider is by searching on our online
provider directory. This provider directory is real-time and
updated on a daily basis to ensure provider data is the most up to
Where do I have providers call if they have a question on their
reimbursement or contract?
Prime Health is dedicated to quick resolutions of disputed
claims. To help ensure proper actions will be taken please contact
Prime Health's Dispute/Reconsideration Department at 1-866-348-3887
What types of providers are in the Prime Health network?
The Prime Health network includes all physicians, facilities and
hospitals that are eligible for participation, provided they meet
and can comply with our credentialing guidelines.
Can Prime Health customize your network for the client?
Yes, Prime Health offers customization through our nomination
process. Please contact your Account Manager for further
What is your grievance procedure and process for removing
physicians from your network?
Prime Health maintains a complaint/grievance and appeal system
that provides reasonable procedures for the resolution of oral or
written complaints/grievances initiated by injured employees, their
representatives, or health care providers. Please contact your
Account Manager for further information.
How large is your PPO network?
Prime Health has over 700,000 providers nationwide in all 50
states and growing. We continually add new providers daily based on
our client's needs to ensure penetration and savings continue to
Is Prime Health compliant with HIPAA regulations?
Yes, we follow all HIPAA regulations and are electronically
Is Prime Health a certified network in any states?
Yes, please contact your Sales Executive or Account Manager for
information regarding the states of certification at
How often does Prime Health validate your network
Provider demographic verification is performed on an ongoing
basis within several different departments at Prime Health
including our Provider Updates Department, Credentialing
Department, and our Call Center. All changes made by our provider
updates staff are made in real time so that our clients realize the
changes and additions immediately.
Is your credentialing of providers outsourced?
No, all credentialing is done internally following URAC