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Group Health

Navigating the Changing Landscape of Group Health

Group Health was designed to give employees and their families access to affordable, high-quality healthcare while helping employers manage benefit costs. Over the years, it has evolved into a complex system shaped by rising medical expenses, shifting regulations, and the growing demand for customized healthcare solutions.

Today, Group Health plans require the integration of advanced technology, robust networks, and streamlined claims management to balance cost control with quality care. Employers, carriers, and TPAs need a trusted partner who can simplify these processes while maintaining compliance and efficiency.

Prime Health Services brings together the expertise, technology, and flexibility needed to help you navigate this changing landscape with confidence. Through Renovo Technology Solutions, we deliver innovative cost containment services, customized network solutions, and a technology-driven platform designed to keep your Group Health programs running smoothly.

Why Choose Prime Health Services?

Technology-Driven Efficiency

Web-based tools with sub-second response times for claims validation and processing.

Custom Network Solutions

Options based on Medicare discounts, geographic carve-outs, and threshold discounts to maximize savings.

Commitment to Data Integrity

We follow URAC and NCQH credentialing standards and are a member of the Synaptic Health Alliance.

Proven Network Adequacy

With our Healthy Network Report, provider nomination system, and dedicated relations team, you always get the coverage you need.

Comprehensive National Coverage

With 850,000+ providers across all 50 states, we offer:

Network & Cost Containment Solutions

Full Network

Our Full Network delivers broad, nationwide access with over 850,000 providers across all 50 states. It ensures maximum coverage and flexibility while maintaining competitive discounts. This option is ideal for clients who need comprehensive access for a diverse member population.

Physician-Only Network

The Physician-Only Network focuses exclusively on physician access, providing cost-effective solutions for plans that do not require facility coverage. It streamlines care by directing members to high-quality doctors while optimizing savings.

Supplemental Network

Our Supplemental Network allows clients to enhance their existing provider base. By filling in geographic or specialty gaps, it strengthens network adequacy and supports members in underserved areas without replacing a current network strategy.

Wrap Network

The Wrap Network serves as a safety net for claims falling outside a primary PPO. It ensures members always have access to discounted care nationwide, protecting against out-of-network costs while maintaining predictable savings.

Custom Network

With the Custom Network, clients can tailor their coverage based on geography, provider types, or discount thresholds. This solution is ideal for employers or TPAs with unique population needs, allowing for carve-outs, Medicare-based discounts, or narrow network design.

Claims Management Services

Our advanced Claims Management solutions ensure claims accuracy and maximize cost savings through:
✔️ Automated claim auditing to identify billing discrepancies
✔️ UCR (Usual, Customary & Reasonable) and Medicare-based pricing reviews
✔️ Fraud, Waste & Abuse detection for additional cost containment

Technology-Driven Claims Management

✔️ Real-Time Claims Editing

Instant validation, repricing, and compliance checks

✔️ Front-End Edits

Reduces errors and claim severity before processing

✔️ Seamless Integration

Fully automates PPO network and invoicing processes

To Make Requests For Further Information,
Contact Us!

Call Us Or Email For Any inquiry

Phone: (866) 348-3887
Email: info@primehealthservices.com