Claim Disputes
Claim Dispute Resolution
Prime Health Services has a dedicated repricing and reconsideration department that works on behalf of our providers, with cooperating partner networks and clients to resolve claim disputes.
Please note that Prime Health is unable to address questions regarding the application of bill review or state-mandated fee schedule reductions. These questions should be directed to the insurance carrier and/or bill review vendor listed on your explanation of benefits/review.
Prime Health is happy to assist in resolving claim disputes stemming from the application of a Prime Health network or Partner Network reduction. Part of the nature of a Preferred Provider network is addressing an industry average of 3% claim disputes. However, Prime Health is proud to have a dispute average of 1.2%.
Why Dispute Claims?
The EOB/EOR (Explanation of Benefits / Review) does not properly list Prime Health or our Partner Network.
The provider does not recognize their contract with Prime Health or our Partner Network.
An error in repricing the claim occurs with Prime Health or the client.
Questions regarding the calculation of discount.
Dispute Submission Guidelines
1. Provider or Patient Name
Include the provider name or patient name in the subject line.
2. Copy of EOB/EOR and Claim Form
Attach a copy of the EOB/EOR and the corresponding claim form that is being disputed.
3. Explanation of Dispute
Provide a brief explanation of the dispute.
4. Contact Information
Provide a contact name and number of the person submitting the dispute.
Submitting Claims to Prime Health
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 our Claims Resolution Department at 1-866-348-3887. Prime Health is dedicated to a fast response for disputed claims which applied a Prime Health discount. Our average turnaround for dispute resolution is 5 to 7 business days.
Payment Status
Please note that Prime Health is not the carrier and thus 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 our Providers to change their billing practices. Our claims submission process should follow your normal course of practice. Should you ever have questions or concerns, please contact our customer service center at customerservice@primehealthservices.com.
Client and Claims Inquiries
If you have questions about our clients or the claims they have paid, please email the specific issue to claimsinquiries@primehealthservices.com.
We look forward to working with you and appreciate your participation in our network.