Administrative & Health-Systems Services

Our administrative and health systems services focus on improving care, reducing cost and administrative health-care burdens to our business clients. Our services and solution align with a value-based reimbursement model and helps prevent reimbursement penalties to clients.

We help clients provide better care for individuals by reducing unnecessary re-hospitalizations and emergency department visits, helping providers focus on direct patient care instead of administrative healthcare tasks, supporting compliance with claims and billing, providing quality and trusted independent medical review solutions, delivering healthcare staffing solutions, and reducing overall healthcare costs.

Our approach complements and integrates well with existing client programs and resources and delivers positive measurable impacts on Star and HEDIS ratings.

Our administrative and health systems services include independent medical review services through our subsidiary prime medical review solutions, prior authorization (PA) management services, healthcare staffing solutions, health-care cost management services, and hospital readmission management services.

Prime Medical Review Solutions (PMRS), a subsidiary to Prime Care Health Solutions, is an independent peer review organization serving the public and private healthcare sectors. Our broad range of services includes utilization management, independent and external peer review. Prime Medical Review Solutions (PMRS) has an extensive pool of clinical peer reviewers in active practice that permits us to maintain effective, quality and timely peer review

We can manage your entire prior authorization (PA) process. Our services includes management of PA submission, follow-up, peer to peer consultations, appeals for denials, pharmacy & medical benefit investigation, patient medication assistance program enrollment & support, patient engagement & refill adherence services, PA status updates, pharmacist consultation for medication alternatives and therapeutic drug monitoring service.

Is your organization in need of temporary or permanent healthcare professionals? Prime Care Health has the solution to help your organization address short-term and long-term absences and national healthcare staffing shortages. We have meticulously developed the resources to respond to your planned or unplanned absences in an efficient and cost-effective manner. From nurses, physicians, pharmacists and allied -health clinician staffing and recruiting, we can be trusted to deliver a broad pool of the most talented candidates to meet your organization’s staffing needs.

We offer a value based approach to health-care cost management that reduces cost, improves quality and ensures compliance while maximizing revenue to your organization. Our cost management service includes medical claims review, bill audit and recovery services. We help you reduce the cost associated with providing care without compromising patient care. We partner with highly qualified vendors to provide bill audits that ensure maximum savings and proper payment for services rendered.

Let us help reduce your patient re-admission rates through utilization of our clinically based care management programs and transition of care services. We provide intervention programs that focus on reducing hospital re-admission in high-risk patient groups. We partner with our business clients to stratify their most vulnerable patient population and focus our efforts on those patients with multiple chronic conditions, the elderly and patients recovering from high-risk procedures. We provide discharge counseling, in person or telephonic follow-up post discharge, re-enforcement of care plan, triage services, along with pharmacist medication management services that reduces hospital re-admission rates and improves patient outcomes.