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. Our EHP offers high quality care at the lowest cost. 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 Management 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.
To download and review the most recent Authorization Process and comprehensive list of services that do not need prior authorization when rendered by a Tier1 Specialist (effective 3/1/2023), click here.
The Prime EPO is a nationwide plan. Based on differing availability of providers in the communities we serve, your benefit tiers may vary slightly from what is shown above.