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Prime Health Services

Patient Frequently Asked Questions

How can I find a local Provider?

You can access our Provider Search tool by clicking the yellow button above. With this flexible tool you can search for providers in your area. You do not need to fill in all of the form fields. Filling in only the zip code will provide a more select number of providers. To broaden your search fill in only the county name.


Is my current Provider in your network?

Click on the Provider Search button above to search for providers. You must type in the correct spelling to locate a specific provider. You are not required to fill in all the fields in the form.


Why is my provider not listed in your network?

There could be several reasons why your provider might not show up in the provider search. Please check for the following and try your search again:
- Spelling mistakes
- Please verify the spelling of your provider's name or location and try again
- Too specific criteria
- Please remove some of the criteria to broaden your search
- Tip: Try typing a few letters of the provider's name instead of the entire name
- Incorrect abbreviations
- Try both the complete spelling and the abbreviation for words such as "FT" and "FORT" or "ST" and "SAINT"

If none of the above suggestions help, your provider may not be in our network. Click Nominate a Provider to nominate them and our contracting staff will contact them requesting they join our network.


If there is more than one provider in the office will they all be in the network?

Usually, they will all be covered, but not always. Some medical providers are contracted with Prime Health Services via their practice name or Federal Tax ID Number (TIN). In those cases, all of the doctors or other medical providers are covered. However, medical providers sometimes choose to not participate with us, even though their associates do. The only way to know for sure is to check participation of the provider on our website provider search function or to contact Prime Health Services at 866-348-3887.


Can I enroll my Provider in your network?

Yes. We are continually building our network of providers. Go to our Nominate Provider page under the Patient tab above. Please enter as much information below as you can for the provider you would like to nominate. We will immediately contact the provider.


How can I find out what percentage of my medical costs are covered and is there a co-pay?

Prime Health Services is the PPO Network being used by your Group Health payor. Prime Health does not establish the payment structure for your medical benefits, but typically most plans operate on a set percentage for using an in-network provider, versus using an out-of-network provider. Please contact your Group Health payor to find out what differentials are covered under your particular policy guidelines.


I currently have a work-related injury. Can I contact a provider directly?

In order to process a workers' comp related claim, you must first report your injury to the employer or TPA. They will instruct you on the type of provider you should see. What can I do if my doctor bills me for the balance of a work-related injury claim? Contact your work comp insurance company and have them send a brief description of what the provider is disputing, along with the claim and EOR via email at claimdisputes@prime-health.net or fax at 615-329-4411.


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 serving the insurance industry since 1996.