The Prime Health Services corporate office is still open and operating at this time. Employees, please refer to MS Teams and your email for the latest office updates.


About Our Provider Network

<p><span data-doc-id="7851991000003135001" data-doc-type="function(){return"writer"}">Prime Health Services specializes in quality PPO development and </span>is uniquely positioned to offer the largest directly contracted network of medical providers that is available. Our preferred provider network serves the workers’ compensation, commercial group health, corrections (indigent care), Medicare, and auto liability markets.</p>

Looking For Something More?

<p class="zw-paragraph" data-textformat="{"ff":"Campton","fw_i":600}" data-doc-id="7851991000003135001" data-doc-type="function(){return"writer"}"><strong>Looking for a preferred provider network that is more than just “dots on the map”? </strong></p> <p>Network development is our focus and passion. While we do have providers located in all 50 states, our focus is in developing provider networks that meet the specific needs of our individual clients. This is accomplished through customization and effective contracting in which there is no confusion on the part of the provider as to which of the market segments they are contractually agreeing to provide services. Our network of providers is comprised of those hand-selected based on their quality of care and strategic location. As a provider in the Prime Health Services Network, you will help assure that the best care is provided – yours!</p>

Take a look at what we offer.

Workers’ Compensation PPO

Our most prolific product is the customized network of strategically selected providers who have demonstrated a historical understanding of the unique requirements involved in treating workers’ comp injuries, and / or are receiving a large percentage of our clients’ medical payments.

Group Health PPO

We provide our clients with access to physicians, ancillary services, and hospitals nationwide. We are committed to the continual growth of this network to further meet the needs of our group health clients.

Auto PPO

Physicians, ancillary services, and hospitals providing first-party auto PPO care for our clients. Leading auto insurers are not only looking for access to a premier network contracted to handle the unique injuries of the motor vehicle injured patient, but as referral sources to make sure that follow-up care, beyond the emergency room, is accessed. 

Along with access to quality care, insurers / payers are looking for quantifiable results in an outcomes-based setting.

Broaden Your Patient Scope

<p>Prime Health’s PPO network is available to the insurance carrier, third-party administrator (TPA), self-insured, government, and captive insurance entities. We have a vast client list spread across many industries.</p> <p>Being a privately-owned company allows us to be nimble to give our providers prompt service and personal attention. One of the fastest growing preferred provider networks in the nation, our core philosophy is giving our clients access to the medical providers of their choice instead of forcing them into a pre-established network. Ensuring each provider we work with knows exactly what services they are agreeing to is key to servicing our clients and their employees or members in the best way. </p>

Benefits of Joining the Prime PPO Network

Not all PPO networks are the same. We strive to have a mutually beneficial relationship with our in-network medical providers, optimally saving you time and money on the administrative side of your business. 


<p><span data-doc-id="7851991000003135001" data-doc-type="function(){return"writer"}">Industry leading real-time bill re-pricing. We save you both time and</span> money. Although our clients are under contract to pay clean claims within 30 days, claims are processed and paid within an average of 14 days because of the advanced EDI platform we built. We have a stake in ensuring Prime Providers benefit from our agreement financially and are paid in a timely manner; we are not paid until our providers are paid.</p>


<p>All provider contracting, credentialing, and re-credentialing is handled in-house, delivering a level of unrivaled quality. Delegated credentialing is available if your organization already credentials your providers in adherence to a recognized standard such as URAC, NCQA, JCAHO, etc., saving you time in the often-tedious process of credentialing.</p>


<p>We have the capability to track the progress of our contracts, comparing previous versus current patient quantity to show periodically the patient increase, client origin, and the additional revenue resulting from their affiliation with our network.</p>

Referral Management System

<p><span data-doc-id="7851991000003135001" data-doc-type="function(){return"writer"}">Clients have online access to our provider nomination</span> tool, QueBall, which allows them to submit their provider nominations at the click of a button. The marketing we perform on behalf of our providers is pinpointed to the clients, case managers, patients, etc. that will actually be seeing you. Our website, social media pages, the provider directory, newsletter, and conferences are examples of how we continuously promote our network of providers to our client community.</p>

Provider Disputes | Provider Relations

<p><span data-doc-id="7851991000003135001" data-doc-type="function(){return"writer"}">Provider disputes average less than 1%</span> nationally and provider retention is over 99%. In large part, this is because of our contracting methodology and commitment to resolving provider issues within one business day. We also have a Provider Relations team that is dedicated to you.</p>

Notices and Updates

Based on the disclosures required of group health plans and health insurance issuers in the No Surprises Act, Prime Health will provide the in-network providers’ negotiated rates.

Providing these deliverables allows transparency within tasks being asked of our clients and our clients’ clients.

At Prime Health, our provider contracts are evergreen and we can track when a provider (NPI) status is disabled or a contract (TIN) is termed. We also track dates on contracts and discounts when they are added/changed.

Prime Health uses commercially reasonable efforts to maintain accurate provider directories, which are regularly updated and verified at least every 90 days. Prime Health will respond, within one business day, to individuals who inquire about the network status of a provider or facility.

To aid in this initiative, with the use of technology, Prime Health is working with industry leaders in the provider data collection and verification space.

Beginning July 1, 2022, health care providers will need to:

• Submit the CMS-1500 form. Electronic submission through an XML submission partner is strongly encouraged, though not required. When mandatory submission of the CMS-1500 form begins, use of current medical billing/reports including Doctor’s Initial Report (Form C-4) and Doctor’s Progress Report (Form C-4.2) will be discontinued.

• Prominently report the injured worker’s temporary impairment percentage, work status and the causal relationship of the injury at the top of the CMS-1500 form medical narrative.

Between now and July 1, 2022 health care providers are urged to review their processes to understand how these changes will affect them. The Board will continue to post periodic updates to the website based on feedback and questions received from stakeholders.

More information can be found at http://www.wcb.ny.gov/CMS-1500/