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%.
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.
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
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
Client and Claims Inquiries
We look forward to working with you and appreciate your participation in our network.
