PPO Services

The Prime Health networks are more than just "dots on the map" and deep discounts. While we do have providers located all across the nation with competitive discounts, our focus is in developing provider networks that meet the specific needs of our individual clients. This is done through customization and effective contracting in which there is no confusion on the part of the provider as to which of the market segments they are contractually agreeing to provide discounted services.

Workers Compensation - Our workers compensation network of over 700,000 providers is customized to include providers who have demonstrated a historical understanding of the unique requirements involved in treating workers compensation injuries, and/or are receiving a large percentage of our clients' medical payments.

Group Health  - Prime Health's Group Health PPO provides our clients access to over 700,000 physicians, ancillary services and hospitals nationwide. We are committed to the continuing growth of this network to further meet the needs of our group health clients.

Auto PPO - Prime Health's Auto PPO has over 450,000 physicians, ancillary services and hospitals with providers in all 50 states and the District of Columbia, providing first-party Auto PPO care and aggressive savings for our clients.

Additional features:

Technology - Industry leading real-time bill repricing through our industry-standard re-pricing and reporting platforms.

Credentialing - All provider contracting, credentialing and re-credentialing are done in-house. This is not "subbed out" to a third party, delivering a level of quality not rivaled by any of our competitors.

Customization - We run DAILY client reports that identify out-of-network providers on the last day's claim run. This list is sorted by "dollar amount" and "frequency of claim", and is then delivered to our team of professional contracting specialists to be worked. The provider is contacted for contracting into the network. NO other network has committed the resources or shown the same level of expertise when it comes to network customization.

QueBall Nomination Management System - QueBall gives our clients online access to our provider nomination tool. Through QueBall, our clients can submit their nomination online. Our network development team will then work to recruit the provider into the Prime Health network on behalf of our client.

Provider Disputes/Provider Retention - Provider disputes average less than 1% nationally and provider retention is over 99% in large part because of our contracting methodology and our commitment to resolving nearly all provider issues in one business day.