Frequently Asked Questions
How can I find a local provider?
To search for healhcare providers in your area, click on Search and set your location.
Select your department / employer location from the choices shown. Please be aware that there may be more than one page of possibilities; click either the “Next” or “Last” button underneath the list of employer address choices or select a specific page number you’d like to jump to.
Or click "Set Custom Location" to set your specific address. Then select "Use this location."
You do not need to fill in all of the form fields. Filling in only the zip code will provide a more select number of providers. To broaden your search fill in only the county name.
How do I change my Location?
To change your location, simply click the CHANGE button located on the top right corner of the Search Filters box as seen here:
Then simply follow the same steps for setting your location listed above.
Is my current Doctor in your network?
To locate a specific medical provider, click on Search and fill out the form. Please be aware that you must type in the correct spelling to find a specific provider. You are not required to fill in all the form fields.
Why is my provider not listed in your network?
There could be a number of reasons why your medical provider might not show up in the provider search. Please check the following common reasons and try your search again:
- Spelling mistakes—Please verify the spelling of your provider’ name and double check there are no other spelling errors on the form.
- Incorrect location—On occasion, the provider’s location is entered incorrectly. Please verify.
- Too specific criteria—Please remove some of the criterial (like small radius, specific specializations, etc.) to broaden your search. That may help find the provider you are trying to search. Tip: Try typing a few letters of the provider’s name instead of the entire name (i.e. A Smi instead of Alex Smith). Sometimes that helps.
If there is more than one healthcare provider in the medical office I go to will they all be in the Prime PPO network?
Usually, but not always. Some medical providers contract with Prime Health Services via their practice name or Federal Tax ID Number (TIN); in those cases all of the doctors or other medical providers are covered. However, sometimes medical providers choose to not participate with us even though their associates do.
The only way to know for sure is to check our Provider Search tool or to contact Prime Health Services toll-free at 1-866-348-3887.
Can I enroll my provider in your network?
Absolutely! We are continually building our network of providers so welcome all referrals. Click on Nominate Provider and enter as much information on the form as you can, for the provider you would like to nominate. The Prime Health Services Contracting Department will immediately contact the provider to join our PPO network.
What should I do if my doctor bills me for the balance of a work-related injury claim
Contact your workers’ compensation insurance company if you are billed for a work-related injury claim. Ask them to send the following to email@example.com with “Employee Claim Dispute” in the subject line:
- Brief description of what the provider is disputing (what you are being charged for)
- A copy of the claim
- The EOR (explanation of reimbursement)
Or they can send a fax to 615-329-4411 at the attention of "Employee Claim Dispute."
How accurate is this information?
We make every effort to ensure that the list of providers/practitioners displayed is up to date and accurate. Prime Health has a dedicated Updates Department, Call Center Department, Credentialing Department, and Data Quality Management Department that has ongoing projects to ensure our data has the most up to date information. All changes made by our provider updates staff are made in real time so that our clients realize the changes and additions immediately.
What is an approved Health Care Network (HCN)?
An HCN is an entity that must obtain certification from the Texas Department of Insurance (TDI). That certification is contingent upon the HCN meeting all requirements of Chapter 1305 and HCN rules. A certified HCN should offer quality medical care to an injured employee that is appropriate to cure or relieve the effects of a work-related injury. Employers who elect to enroll in an HCN can require injured employees to receieve treatment for their work-related injuries from providers in the HCN.
If I am an injured worker where do I go for the latest information on my workers' compensation benefits and resources?
The Texas Department of Insurance (TDI) website will have answers to your questions, as well as resources available to you, like the notice of injury packet and contact information: www.tdi.texas.gov/wc/employee/index.html
Where can I access a list of FAQs?
Employee frequently asked questions and answers can be found on the Texas Departement of Insurance (TDI) website:
What if the TDI website does not answer my question?
Please call TDI directly. Per their website, "For assistance with a workers' compensation claim, please contact Claims & Customer Services at 800-252-7031, option 1."
If I need a list of Employer related FAQs and information where do I go?
If you need information from the Employer's perspective please refer to the Texas Department of Insurance (TDI) website: www.tdi.texas.gov/wc/employer/index.html
Prime Health Services, Inc.
PO Box 660675
Dallas, TX 75266-0675
P.O. Box 26850
Austin, TX 78755
Voice: (512) 212-7064
Claim Dept. Fax: (512) 231-8248