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Inmate Medical Cost Containment


Prime Health Services is a leader in managed care, and part of
that medical cost containment focus is for the corrections
industry. Our ability to offer comprehensive programs for jails and
prisons of any size is what puts us on the cutting edge of the
healthcare sector.
For inmates that need off-site medical care, we are able to
offer you our network of medical providers whether that be x-ray
facilities, dentists, chiropractors, optical offices, or hospital
services. When going to an in-network medical provider, we are able
to save the sheriff's office money on the bill. Even if the
sheriff's office already has a discount with the local hospital, we
may have a better negotiated rate and, in addition, we also have a
broader network that provides coverage if an inmate needs services
not provided by that local hospital.
Easy, Free Program
Our inmate off-site medical cost containment program doesn't
cost the sheriff's office money, it saves money. And time.
- When an inmate needs off-site medical service, simply call the
toll-free number to pre-verify the service. The sheriff's office
will present a PHS identification card to the medical provider to
ensure they have the correct billing information.
- After treatment, the bill is sent directly to PHS and we
process the claim for you. The bill is "scrubbed" by our
state-of-the-art software to ensure only appropriate claim charges
on the bills are reimbursed. Scrubbing is performed at the detail
line level and includes industry standard edits such as unathorized
/ inappropriate services on the claim, incomplete claims, duplicate
claims, invalid or excessive codes, and unbundled
charges.
- After the claim has been processed, the sheriff's office will
receive an invoice from Prime Health Services. The sheriff's office
will write PHS a check for any invoices received. Once full payment
is received by PHS, we will pay all of the providers of those
claims for the sheriff's office taking that burden off of your
staff.
The sheriff's office "pays" for the program through a percentage
of savings from the medical bill. Prime Health Services doesn't get
paid unless we save the sheriff's office money.
Off-site National Provider Network
Prime Health Services offers the corrections industry access to
our network of directly contracted medical providers. We are
experts at direct contracting with providers and have taken our
experience in the workers' compensation and group health industries
to help the corrections industry save money on medical
care.
Even if you have an on-site medical in place, we are your
off-site experts. Our proprietary software that scrubs bills for
accuracy and savings offers unparalleled service even if your
on-site staff say they can assist with off-site claim
processing.
- Offers better coverage for your facility - providers that are
willing and have contracturally agreed to see inmates (there's no
confusion)
- Receive deeper discounts from medical providers based off of
our negotiated contracts
- Reports are customized to benefit you and your facility
- Option for MedTrack integration that ties our nationwide
off-site provider network to our online tool for managing your
inmate population's medical incidents
Online Inmate Medical Tracking
MedTrac inmate medical tracking system is Prime Health Services'
online tool for managing your entire inmate population's medical
incidents from beginning to end with comprehensive solutions for
budgeting, tracking, and scheduling.
WEB BASED COMPREHENSIVE CUSTOMIZED TECHNOLOGY BASED

Claims Management
- Identifies and tracks trends in your off-site care utilization
and costs.
- Claims Auditing
-Eliminating duplicate claims
-Identifying coding errors
- Claims Processing - 2 ways you can access the Prime Health
Provider Network
Real-time EDI Solutions
- One of the first to market with this technology
- Claims are processed within seconds of being received (not
hours or even days)
- Allows Prime Health to capture data for all types of analysis
for you
Renovo System
- Enables us to easily and quickly put our network into our
clients' hands.
- Increased reporting capabilities
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Utilization Management
- Continual quality improvement with controlled costs
Utilization Review
- Provides you with an independent review of medical cases to
help ensure cost-effective, clinically appropriate care
TPA Services
- Accurate billing with audit checks
- Fast turnaround to pay providers quickly
- Accessible online reporting of savings so you know what the
claim cost and savings are at any point in time
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