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Prime Health Services

Client FAQs

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 1996.

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 clients?

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 needs.

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 Health Network?

To obtain additional information on the Prime Health Network, please contact at Prime Health's Sales Executive at 1-866-348-3887.

How do I nominate a provider to become in network?

Please visit our Provider Nominations page or contact your Account Manager.

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 date information.

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 or

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 information.

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 increase.

Is Prime Health compliant with HIPAA regulations?

Yes, we follow all HIPAA regulations and are electronically compliant.

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 1-866-348-3887.

How often does Prime Health validate your network information/demographics?

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 standards.