Welcome to a nationwide provider network built for access, speed, and service.
Prime Health Services connects participating providers with clients across Workers’ Compensation, Auto Liability, Group Health, Personal Injury, Corrections, and Medicare Advantage markets.
Everything your team needs, organized for real-world use.
Smooth network onboarding starts here.
Use this checklist as an internal tracker while your team reviews the manual. The checklist now stays on the right side of the page on desktop, so it remains easy to update as you scroll through the checklist items.
Help your staff identify the product line quickly.
Different client populations may present different cards, documents, EOBs, or instructions. Use the tabs below as a front desk quick guide.
What to look for
Prime Health Services logo and contact information will be present on the Explanation of Benefits or Explanation of Reimbursement.
Claims note
Workers’ Compensation claims should be submitted to the address requested by the Case Manager or Adjustor.
Member ID card
The ID card may include the Prime Health Services or PHS+ logo, a toll-free verification number, or EOB language noting the PPO network relationship.
Submit claims to
Use the address on the back of the group health identification card and include provider, patient, employer, policy, and coding information.
Sample ID card
Use this as a quick visual reference when checking for Prime Health Services or PHS+ identification details.
Medical Access Pass
Personal Injury members may present a Medical Access Pass. This is not an insurance card, but it confirms the patient relationship with PHS and the client.
Scheduling flow
Prime Scheduling coordinates the in-network appointment, confirms with the patient, and follows up after treatment.
Medical Access Pass
Use this example to help staff recognize the Medical Access Pass during patient intake.
County jail inmates
Inmates receiving off-site medical care should be accompanied by a sheriff’s office representative.
Important billing step
Obtain a copy of the Prime Corrections ID Card at the time of service. It identifies the client and includes billing instructions.
Sample Corrections ID card
Use this example as a quick visual reference for identifying Prime Corrections county ID card details during intake and billing.
PHS+ logo
In Medicare markets, client plans have been reviewed and approved for operation by CMS. Members will hold identification cards bearing the PHS+ logo.
Verification
Follow the plan-specific instructions and contact points tied to the member’s plan and identification card.
Before service, verify the right way.
Eligibility, authorization, and pre-certification requirements may differ by product line and plan.
Group Health
Use the toll-free phone number listed on the Group Health card for eligibility and benefits.
Workers’ Comp
Verification is handled when the appointment is scheduled by the case manager or adjustor.
Personal Injury
Cards include customer service, scheduling, and patient coverage or authorization phone numbers.
Pre-Certification
Contact the insured’s plan for services that require pre-certification or utilization management.
Clear claims guidance without the clutter.
Claims should be submitted using the appropriate industry form and current coding standards. This helps support cleaner processing and reduces back-and-forth.
Professional claims
Submit on a CMS-1500 or standard industry form.
Hospital or facility claims
Submit on a UB-04 or standard industry form.
Submit Group Health claims to the address on the back of the member’s identification card.
Provider information
Include provider name, address, phone, TIN, State License Number, and NPI Number.
Patient and policy information
Include patient name, covered person name and Social Security number, employer name, policy number, and appropriate codes.
Submit Workers’ Compensation and Auto claims in the same general format as Group Health claims, but send them to the address requested by the Case Manager or Adjustor.
Personal Injury claims follow a more specific path. Use the workflow below to keep scheduling, treatment, documentation, and payment steps clear.
Funding company refers patient
The patient is referred into the Prime Scheduling process.
Prime schedules care
Prime coordinates an in-network appointment.
Provider treats patient
The participating provider delivers care.
Prime follows up
Prime confirms the visit and supports next steps.
Provider submits billing
Dictation and bills are sent to Prime.
Personal Injury payments can be issued by eCheck, Wire/ACH, or FedEx. Electronic funding may allow payment in as few as 5 days once required documentation has been received.
High-value policy reminders.
These are the areas teams often need to reference quickly after a claim, appeal, referral, or credentialing update.
Claims and Inquiry Disputes
Submit a copy of the EOB, corresponding claim form, and a brief explanation of the appeal. Typical turnaround time is five business days.
Visit Claim Disputes PageBalance Billing
The contracted rate received from a Payer or Client is considered payment in full. Patients may not be billed the difference between billed charges and the contracted rate.
Recredentialing
Providers are recredentialed every three years, or every two years in Texas. The team will contact providers in advance to resubmit necessary information.
Visit Recredentialing PageReferrals
PHS recommends referrals to contracted in-network providers and encourages providers to comply with client Case Manager and Adjustor requests.
Make a ReferralInterested in becoming a Featured Provider?
Prime Health Services regularly highlights providers across the website and social media to help expand visibility and showcase services to a broader audience.
Route each request to the right team.
Use this section as the quick contact hub for demographics updates, disputes, credentialing, provider relations, and client directory requests.
Provider Demographics Updates
TIN changes, email changes, name changes, provider or location additions, phone or address changes, terminations, and facility closures.
Updates@primehealthservices.comFax: 615-329-4751
Appeals and Disputes
Send the EOB, corresponding claim form, and a brief explanation of appeal.
claimdisputes@primehealthservices.comFax: 615-329-4411
Credentialing & Recredentialing
Submit credentialing questions or documentation.
Credentialing Pagecredentialing@primehealthservices.com
Provider Relations
Patient grievance, admitting privilege changes, network status, client directory requests, client relationship questions, and utilization inquiries.
ProviderRelations@primehealthservices.comCall: (877) 277-4635