Our EHP offers high-quality care at the lowest cost
Prime is known for the quality care we provide to our patients. We are honored to bring that same care to our employees through our self-funded employee health plan.
Prime EHP is an Exclusive Provider Organization (EPO) composed of a Tier 1 Provider Network that includes all Prime medical groups, hospitals, and facilities, as well as carefully chosen contracted Providers.
The EPO Plan covers 100% of preventive care and most inpatient and outpatient hospital-based services at little to no cost when delivered by Prime Tier 1 Providers. There is no annual deductible. Copay and coinsurance are kept to a minimum. Prime also covers most of the monthly premium to keep costs low.
Members receive access to quality care by choosing a Primary Care Physician (PCP) in the Tier 1 Network. The Find a Provider tool, available here and on local Prime Hospital websites, makes it easy. Provider information is also available by clicking through the Tier 1 Provider Directory Files available in the right-side navigation. Try Find a Provider.
Members:
To see how to use the EHP to get the most from your medical benefits, click on the "For Members" section to the right.
For some medical services, PCPs and Providers must request referrals and prior authorizations on behalf of Members. Specialists should submit requests for further care after the initial visit. In Tier 1, these requirements are minimal when Members receive care from Prime Providers and Facilities.
When authorizations are required, they must be approved by Prime Utilization Manangement before Members receive care. Prime has made these approvals faster and easier than ever.
Through our online Prime Authorization System (PAS), 60 percent of requests are approved instantly. 96 to 98 percent are approved overall with 92 percent approved within 24 hours.
If you don't already have PAS access, and want to request prior authorization via fax, please click here to download the form. To request a PAS application login, email EHP@Primehealthcare.com with your group name and tax ID.
We also added a long list of Auto-Approved services that are covered automatically without prior authorization. To download and review the most recent Authorization Process (effective 4/1/2022), including the list of Auto-Approved services, click here.
Already have trusted Providers? Nominate them to join the Prime Healthcare Network.
Please complete and return the Nomination Form. Email it to EHPprovidercontracts@primehealthcare.com or fax it to 909-235-4405.
If Members or Providers disagree with benefit decisions, they may appeal or dispute using the forms below.
- Member Appeal Request - download fillable Microsoft Word form
- Provider Dispute Resolution Request - download fillable Microsoft Word form
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