Auto Casualty
Auto Casualty Solutions
One connected strategy for every auto medical claim.
Prime Health Services helps insurance carriers, TPAs, and claims organizations manage medical costs across first-party and third-party auto claims. Our PPO network and Renovo Technology Solutions connect provider access, configurable bill review, contracted rate application, and clear reporting in one coordinated workflow.
Everything your auto casualty program needs, connected.
Select a capability to see how Prime supports your claims operation from provider access through final reporting.
More than a network. A connected auto casualty strategy.
Prime brings together the provider network, reimbursement review, technology, and service model required to manage medical claims with greater consistency and control.
Coverage-Aware Workflows
Configure review paths around first-party and third-party coverage requirements instead of forcing every claim through the same process.
Integrated Cost Containment
Coordinate applicable fee schedules, UCR benchmarks, PPO reductions, and eligible out-of-network strategies.
Configurable Technology
Use rules, automation, routing, integrations, and reporting designed around your program and claims philosophy.
Dedicated Expertise
Receive implementation guidance, account management, network strategy, and responsive operational support.
A more controlled process that supports accurate payments, timely care, fair claim resolution, and clear client oversight.
Designed for the complexity of PIP, no-fault, and related coverages.
First-party auto claims require careful alignment between coverage, policy language, dates of service, jurisdiction-specific rules, and available benefits. Prime helps make that complexity manageable.
Personal Injury Protection
Support medical bills paid under the insured's own policy, including no-fault programs and state-specific reimbursement requirements.
Medical Payments
Apply coverage-aware review for MedPay bills in states and programs where PIP is not mandated or available.
UM/UIM
Support medical cost review when an uninsured or underinsured driver is responsible for the loss.
Align adjudication with the way your program handles claims.
- Jurisdiction and applicable fee schedule logic
- Date of service and effective-date requirements
- Coverage-specific rules, limits, and routing
- Coding, duplicate, unbundling, and billing edits
- Consistent EOR language and dispute support
Medical cost intelligence for bodily injury claim evaluation.
Third-party bodily injury claims often involve claimant-submitted bills, UCR considerations, settlement demands, and greater litigation exposure. Prime gives adjusters clearer medical cost information without interrupting the claims process.
Move from billed charges to a more defensible medical cost view.
Review claimant medical bills for coding accuracy, applicable market benchmarks, contracted network opportunities, and additional cost-containment options when available.
Provide bill-level detail that helps adjusters evaluate the medical component of a claim.
Apply configured methodologies consistently across providers, jurisdictions, and claim types.
Use PPO access and eligible out-of-network negotiation or pricing options when applicable.
Provider access built around auto casualty claims.
Prime connects clients with a broad PPO network that supports motor vehicle accident-related care while helping claims teams apply contracted reimbursement accurately.
PPO
Configure access around the needs of your program.
- Nationwide access across key provider categories
- Preferred provider nomination and network development
- Network configuration by client, jurisdiction, or coverage
- Access configured at the bill level when appropriate
- Ongoing network and claims performance visibility
The applicable fee schedule or UCR methodology establishes the allowed amount. Contracted PPO reductions are then applied when available and appropriate under the program.
A configurable path from billed charges to a clear, supportable result.
Prime combines automated rules with targeted review paths to improve accuracy, reduce unnecessary touchpoints, and give claims teams a consistent explanation of what changed and why.
Receive
Accept bill and claim data through configured intake and integration channels.
Validate
Confirm coverage, jurisdiction, date of service, coding, and duplicate logic.
Review
Apply fee schedules, UCR benchmarks, and configured bill review edits.
Optimize
Apply PPO reductions and eligible out-of-network strategies when applicable.
Report
Deliver an EOR, decision details, and program-level reporting.
Coding inconsistencies, duplicate billing, unbundling, global-period conflicts, and other configured billing issues.
Eligible bills may move to PRIME FMP+ or out-of-network negotiation after contracted reimbursement options are exhausted or determined not applicable.
Consistent EORs and reporting explain the payable amount, reductions, and rationale for review decisions.
06 / Technology Platform
Technology that adapts to your claims philosophy.
Renovo turns your policies, priorities, and jurisdictional requirements into configurable workflows, giving your team more control without adding unnecessary complexity.
Configurable Rules Engine
Route and adjudicate bills based on coverage, jurisdiction, client logic, and claim characteristics.
Workflow Automation
Move appropriate bills through straight-through processing and route exceptions for additional review.
Dashboards and Analytics
Monitor savings, turnaround, review activity, network use, and other program measures.
APIs and Integrations
Connect Renovo with existing claims systems, workflows, and data exchange requirements.
Consistent Review Outputs
Generate explanations of review and reporting designed for transparency and dispute support.
Secure Client Visibility
Give authorized users access to claim information, reports, and program performance.
A solution configured around your operation and supported by real people.
Technology and network access are only part of the program. Prime works with your team to implement, monitor, and refine the solution as your needs evolve.
Implementation Planning
Align workflows, data exchange, business rules, reporting, and launch requirements.
Dedicated Account Management
Provide a consistent point of contact for performance discussions, questions, and program needs.
Network Strategy
Support provider nominations, access analysis, and client-specific network configuration.
Performance Visibility
Review program data and reporting to identify trends and opportunities for refinement.
Whether you need PPO access, a complete bill review workflow, or a configurable combination of services, Prime can shape the program around your business.
From medical bill to decision-ready result.
Every stage is designed to improve consistency, visibility, and control across your auto casualty program.
Connect
Bring claim, coverage, and medical bill data into the configured workflow.
Configure
Apply the appropriate jurisdiction, coverage, policy, and client logic.
Review
Evaluate coding, reimbursement, PPO access, and applicable cost-containment paths.
Resolve
Return clear payment information, EOR detail, and reporting to the claims team.
Put network access, bill review, and technology to work together.
Talk with Prime about a configurable solution for your first-party and third-party auto medical claims.
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