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Physician Only Network

PRIME Physician Only Network

A seamless solution for reference based pricing, the PRIME physician only network (PRIMEpon) allows our clients flexibility and increased network coverage. In addition, the group health market appreciates the reasonable reimbursement controls while having a strong primary physician base.

Prime Health’s extensive physician only network has over 600,000 providers nationwide primarily built on reference based contracts with a focus on % of Medicare.  Network coverage adequacy; dedicated provider contracting, customization, network gap analysis, healthy network reports, and provider nominations is what allows Prime Health’s clients access a truly customizable program fit specifically for their members. 

Question

What if your medical health plan allowed your employers/employees to choose any provider they want without the fear of unforeseen out of pocket expenses?

Claim Edits

Our clients have the ability to combine both our PRIMEpon and claims editing capabilities through our proprietary claims review software (Renovo). This offers Prime Health clients real-time PPO discounts, along with the most current coding reviews, duplicate detection, industry specific adjustments, as well as client specific rules. A rule-based software application, it ensures accurate payment is made on all claims of all types and sizes and successfully saves the maximum dollar amount without jeopardizing the patient’s care.

Reference Based Pricing

The Reference Based Pricing (RBP) strategy uses Medicare as its foundation in determining reimbursement for the self-insured plans. It’s widely used to promote healthcare service quality and value. This pricing transparency enables informed and comparative purchasing, resulting in better rates and superior value. RBP models establish facility reimbursements by taking the commonly accepted Medicare rate for a particular procedure to allow members to no longer live in restricted “In Network” benefits but choose where he/she wants to go. The result of RBP plans allow for lowered medical costs for both employers and employees and maximize pricing accountability transparency and savings with facilities/hospitals.

Prime Health offers a full RBP Health Plan offering to the self-insured market.