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Client FAQs

Who We Are

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 We Offer

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.

We Are Not 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.

We Are Not A Silent PPO

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.

Our Repricing Methods

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.

Our Repricing Time

Prime Health's real-time EDI Bridge takes 0.25 seconds to reprice a bill/claim.

Who To Contact

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

Nominate A Provider

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

Find A 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.

Provider Claims Resolution

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 claimdisputes@primehealthservices.com.

Types Of Providers

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.

Customized Networks

Yes, Prime Health offers customization through our nomination process. Please contact your Account Manager for further information.

Grievance Appeals System

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.

Our Growing 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.

HIPPA Compliance

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

Certification Status

Yes, please contact your Sales Executive or Account Manager for information regarding the states of certification at 1-866-348-3887.

Demographic Updates

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.

Provider Credentialing

No, all credentialing is done internally following URAC standards.

Have More Questions?

Please reach out to request any info you need; we are happy to answer your inquiries!