Claim Dispute Resolution
Prime Health Services has a dedicated repricing and reconsideration department that works on behalf of providers, cooperating partner networks, and clients to help resolve claim disputes.
Important clarification
Prime Health is unable to address questions regarding the application of bill review or state-mandated fee schedule reductions. Those questions should be directed to the insurance carrier and/or bill review vendor listed on the corresponding Explanation of Benefits or Review.
Prime is proud to maintain a low dispute average.
Prime Health is happy to assist in resolving disputes related to the application of a Prime Health network or Partner Network reduction.
Helping providers resolve disputes with confidence
As part of a Preferred Provider network, claim disputes are a normal part of the process. Prime Health works to address those disputes efficiently while maintaining a dispute average below the industry norm.
Why Dispute Claims?
These are some of the most common reasons providers submit a claim dispute for review.
EOB/EOR Issues
The EOB/EOR, Explanation of Benefits or Review, does not properly list Prime Health or the applicable Partner Network.
Provider Contract Issues
The provider does not recognize their contract with Prime Health or with the applicable Partner Network.
Repricing Errors
An error occurred in the repricing of the claim with Prime Health or with the client.
Discount Calculation
Questions have been raised regarding the calculation of the applicable discount.
Dispute Submission Guidelines
To help the Claims Resolution Department review your dispute quickly, include the following items with your submission.
Provider or Patient Name
Include the provider name or patient name in the subject line.
Copy of EOB/EOR and Claim Form
Attach a copy of the EOB/EOR and the corresponding claim form that is being disputed.
Explanation of Dispute
Provide a brief explanation of the dispute.
Contact Information
Provide a contact name and phone number for the person submitting the dispute.
Submitting Claims to Prime Health
Review the options below for dispute submission, payment-related questions, and billing practice guidance.
How to Submit Disputes
Providers may submit disputes via email at claimdisputes@primehealthservices.com, or via fax to 615-329-4411. Providers with questions may also call the Claims Resolution Department at 1-866-348-3887.
Prime Health is dedicated to a fast response for disputed claims involving a Prime Health discount. The average turnaround for dispute resolution is 5 to 7 business days.
Payment Status
Prime Health is not the carrier and therefore is not the payer of claims. Any questions regarding payment status should be directed to the insurance carrier and/or bill review vendor listed on the corresponding Explanation of Benefits.
Billing Practices
Prime Health Services does not ask providers to change their billing practices. Claims submission should follow your normal course of practice. Questions or concerns may be directed to customerservice@primehealthservices.com.
Claim Dispute Resolution
Prime Health Services has a dedicated repricing and reconsideration department that works on behalf of providers, cooperating partner networks, and clients to help resolve claim disputes.
Important clarification
Prime Health is unable to address questions regarding the application of bill review or state-mandated fee schedule reductions. Those questions should be directed to the insurance carrier and/or bill review vendor listed on the corresponding Explanation of Benefits or Review.
Prime is proud to maintain a low dispute average.
Prime Health is happy to assist in resolving disputes related to the application of a Prime Health network or Partner Network reduction.
Helping providers resolve disputes with confidence
As part of a Preferred Provider network, claim disputes are a normal part of the process. Prime Health works to address those disputes efficiently while maintaining a dispute average below the industry norm.
Why Dispute Claims?
These are some of the most common reasons providers submit a claim dispute for review.
EOB/EOR Issues
The EOB/EOR, Explanation of Benefits or Review, does not properly list Prime Health or the applicable Partner Network.
Provider Contract Issues
The provider does not recognize their contract with Prime Health or with the applicable Partner Network.
Repricing Errors
An error occurred in the repricing of the claim with Prime Health or with the client.
Discount Calculation
Questions have been raised regarding the calculation of the applicable discount.
Dispute Submission Guidelines
To help the Claims Resolution Department review your dispute quickly, include the following items with your submission.
Provider or Patient Name
Include the provider name or patient name in the subject line.
Copy of EOB/EOR and Claim Form
Attach a copy of the EOB/EOR and the corresponding claim form that is being disputed.
Explanation of Dispute
Provide a brief explanation of the dispute.
Contact Information
Provide a contact name and phone number for the person submitting the dispute.
Submitting Claims to Prime Health
Review the options below for dispute submission, payment-related questions, and billing practice guidance.
How to Submit Disputes
Providers may submit disputes via email at claimdisputes@primehealthservices.com, or via fax to 615-329-4411. Providers with questions may also call the Claims Resolution Department at 1-866-348-3887.
Prime Health is dedicated to a fast response for disputed claims involving a Prime Health discount. The average turnaround for dispute resolution is 5 to 7 business days.
Payment Status
Prime Health is not the carrier and therefore is not the payer of claims. Any questions regarding payment status should be directed to the insurance carrier and/or bill review vendor listed on the corresponding Explanation of Benefits.
Billing Practices
Prime Health Services does not ask providers to change their billing practices. Claims submission should follow your normal course of practice. Questions or concerns may be directed to customerservice@primehealthservices.com.