Managing Offsite Inmate Medical Costs with Transparency and Results
The Growth of Comprehensive Prison Healthcare.
Inmate healthcare is not optional, and offsite care is often where correctional budgets feel the greatest pressure. For county jails, that can mean sending inmates offsite for treatment, where utilization and pricing can vary widely.
The result is a cost category that can rise quickly through transportation, emergency care, hospital stays, specialty visits, and recurring follow-up treatment. Even when care is appropriate, inconsistent pricing can make budgeting difficult.
The goal is not to limit necessary care. It is to improve cost control, identify billing issues, and create a more consistent, defensible process for managing offsite inmate medical costs.
Why We Are Different
Experienced Since 2011
With more than a decade in the industry, our team has worked on both sides of corrections, serving as Sheriffs or Jail Administrators and now supporting counties in reducing offsite inmate medical costs.
Experience
2011 to Today
Real-Life Savings:
How Counties Have Cut Costs on Medical Bills
Explore sample claim outcomes that show how counties have reduced high-cost medical bills through negotiated savings and structured reimbursement support.
saved nationwide and counting
North Carolina
Sepsis Due to MRSA
North Carolina
Lymphoma and Nonacute Leukemia
Florida
Air Ambulance Bill
Florida
Atrioventricular Block Complete
State Association Partnerships
Explore the associations and states partnered with Prime Health Services. Select a partnership below to highlight each organization.
Florida Sheriffs’ Association
Corporate partnership representing the state of Florida.
Inmate Medical Cost Containment Program
Prime works to help counties reduce off-site inmate medical costs while allowing staff to stay focused on day-to-day jail operations. Our process supports stronger oversight, better accountability, and a more organized approach to managing inmate medical claims.
One clear process from bill receipt to provider payment
Counties get a more structured workflow, one payment path, and improved visibility into how claims are reviewed, reduced, invoiced, and paid.
Bill Processing Flow
ID Card Provided
The inmate takes a PHS subscriber ID card to the medical provider.
Claim Reviewed
PHS receives the claim and confirms county responsibility.
Bill Scrubbed
Coding errors, duplicate charges, and other issues are reviewed.
Discount Applied
PHS applies the agreed discount through network or negotiation.
County Invoiced
The county is invoiced for the provider amount plus the admin fee.
Single Payment
The county pays PHS for all open invoices by ACH or check.
Providers Paid
PHS pays each medical provider the total amount owed.
Bill Processing Overview
ID Cards for Medical Visits
PHS subscriber ID cards are provided to be taken with the inmate to the medical provider.
Claim Receipt and Responsibility Review
PHS receives the claim and verifies the county’s responsibility.
- If received directly from the county, the claim is considered approved.
- If received from the medical provider, county approval may be needed.
Bill Review and Claim Scrubbing
PHS scrubs and adjusts the claim to identify coding errors, duplicates, erroneous charges, and industry-specific issues.
Discount Application
PHS applies the agreed-upon discount through an in-network provider arrangement or individual claim negotiation.
County Invoice
PHS invoices the county for the provider allowed amount plus the administrative fee.
County Payment
The county pays PHS for all open invoices through ACH or by check.
Provider Payment
PHS pays each medical provider their full approved amount owed.
Inmate Medical Claim Edits - Renovo
Medical Bill Review
Integrated bill review with PPO connectivity, coding review, duplicate detection, industry-specific adjustments, and reporting.
Renovo, our proprietary bill review software, offers clients an application that is integrated with PPO networks along with coding reviews, duplicate detection, and industry specific adjustments.
This seamless program gives you rapid turnaround time, online access, customized features and reporting, and competitive pricing options.
Hover or click any solution card to preview its full description in the detail panel above.
Medical Bill Review
Integrated bill review with PPO connectivity, coding review, duplicate detection, industry-specific adjustments, and reporting.
Renovo, our proprietary bill review software, offers clients an application that is integrated with PPO networks along with coding reviews, duplicate detection, and industry specific adjustments.
This seamless program gives you rapid turnaround time, online access, customized features and reporting, and competitive pricing options.
Scrubbing Claim/Bill Edits
CMS, AMA, and other medical-source bill edits applied directly to an individual bill.
“Bill Edits” is defined as scrubbing edits from CMS, AMA, or any other medical source and applied to an individual bill.
Medicare Repricing
Up-to-date Medicare benchmark pricing maintained for national repricing alignment.
Prime Health systematically stores and maintains up-to-date Medicare pricing methodologies, ensuring our clients have access to benchmark pricing and the capability to reprice services in alignment with nationwide Medicare rates.
UCR Repricing
National benchmark repricing based on Prime Health’s comprehensive UCR database.
Prime Health manages a comprehensive UCR database to provide our clients with access to benchmark pricing and the ability to perform repricing according to UCR standards on a national scale.
Negotiations
Qualified negotiation professionals research and negotiate bills for an appropriate level of payment.
The Prime Health negotiations solution utilizes our very own qualified negotiations professionals who pay close attention to medical charge billing while thoughtfully and expeditiously researching and negotiating bills for appropriate level of payment.
Implants (PRIMEsurgicalimplants)
Surgical implant assessment using savings and reduction modules to improve pricing transparency and reimbursement objectivity.
This solution meticulously assesses surgical implants through six essential savings and reduction modules, aiming to greatly reduce costs and offer clear insights into trends that inform medical managers.
Prime’s data-driven systems improve pricing transparency and objectivity for surgical implant devices. Our comprehensive evaluations guarantee fair reimbursement, providing clients with robust assurance and support for their pricing strategy.
Fair Market Pricing (FMP+)
Parameter-based pricing supported by nationwide reimbursement, charge, cost, and negotiated result data.
The Prime FMP+ methodology will be deployed based solely upon pre-established and mutually agreed to parameters, such as state, provider type, bill type, bill amount, etc.
The methodology applied is based on annualized reimbursement data from a nationwide dataset of average and accepted reimbursements, reported cost data, historical charge reports and negotiated results for each bill.
State & Federal Fee Schedules
Current state and federal fee schedules maintained in a database for compliant repricing access.
Prime Health efficiently maintains current State and Federal Fee Schedules within a robust database, enabling our clients to access repricing options that adhere to regulatory requirements across various states and federally mandated programs.
Medical Treatment Guidelines, Official Disability Guidelines (ODG)
Evidence-based medical treatment, return-to-work, and formulary guidance supported by claims analytics.
Leveraging ODG’s industry-leading medical treatment and return-to-work protocols, along with an extensive drug formulary for workers’ compensation, our solutions integrate evidence-based medical literature with advanced claims data analytics.
This synergy optimizes outcomes by ensuring appropriate intervention levels tailored to individual cases.
Fraud, Waste, & Abuse (FWA)
Provider-centric technology designed to detect Fraud, Waste, and Abuse beyond conventional bill review.
Adaptive Bill Review platform maximizes claims cost savings beyond conventional comprehensive bill review with a patented provider-centric technology that enables detection of FWA you know is there but can’t see today.
What Sheriffs and Association Leaders Are Saying
Real feedback from leaders who have seen the impact of Prime Health Services and Prime Corrections firsthand.
Podcast Video + Episode List
Featured Video
Episode Playlist
Meet Our Corrections Team
Connect with the people helping support Prime Corrections through sales, operations, and administrative leadership.
Nico F. DiGioia
Director of Sales, Corrections
A key contact for Prime Corrections sales and relationship development, helping connect organizations with the right solutions and support.
Start the Conversation
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Further Information,
Contact Us!
Call Us Or Email For Any inquiry
Phone:
(855) 404-9857
Email: Corrections@primehealthservices.com