Thank you for participating in Premier Health Group (PHG). Our goal is to provide you with high-value support and resources, so that you can focus on what you do best—providing excellent patient care.

Premier Health Group is the comprehensive network of providers supporting the Premier Health Plan. Premier Health Plan pays claims and provides administrative support on behalf of Premier Health Group. Premier Health Plan offers five different types of plans for members of our community:

  • Premier Health Employee Plan, for Premier’s employees and families
  • Premier Health Advantage, for Medicare-eligible individuals
  • Premier Health Advantage VIP, for individuals eligible for Medicare and Medicaid
  • Premier Health Business Value, for businesses to offer to their employees
  • Premier HealthOne, for individuals and families under age 65 who are purchasing coverage both on and off the exchanges

Our goal is to work with you and your office staff to make sure all the resources you need are available to serve these members of the Premier family.

If certain situations require further explanation, call Provider Services at (855) 514-3678(855) 514-3678 from Monday-Friday, 8:00 am - 5:00 pm.

Thank you for joining our mission to build healthier communities in Southwestern Ohio.

Sincerely,

Jerry Clark, MD, FACP
President and Chief Medical Officer
Premier Health Group

How to Use This Manual

This manual provides physicians, office managers and other health care practitioners with a guide to Premier Health Group’s business and medical management practices. Sections include:

  1. Key Contacts
  2. Provider Standards and Procedures
  3. Population Health
  4. Claims Procedures
  5. Member Administration
  6. Pharmacy Services
  7. Vendor Management
  8. Special Needs Plan Administration

Premier Health Group will update this manual and post revisions as needed.

Provider OnLine

Provider OnLine can significantly reduce the number of telephone calls providers need to make to Premier Health Plan. This secure, online service allows providers to:

  1. Check member eligibility and benefits
  2. Submit claims for reimbursement
  3. Check on the status of a claim
  4. Send and receive messages
  5. Complete authorization requests

To view information about an eligible member, providers need to login to Provider OnLine and enter the following:

  1. Member’s full name
  2. Member’s social security number
  3. Member’s identification number

The database then reveals the member's specific benefits and the date such benefits became effective.

Registration and login information for Provider Online is available http://www.premierhealthplan.org/Providers/Provider-Manual/.

Internet Site

The Premier Health Plan website is located at http://www.premierhealthplan.org/. Physicians can find the following information on the website:

  • Provider manual http://www.premierhealthplan.org/Providers/Provider-Manual/
  • Provider information — links to various other Premier Health Group documents for providers http://www.premierhealthplan.org/Providers/Provider-Resources/
  • Utilization Management information including prior authorization requirements http://www.premierhealthplan.org/Providers/Provider-Resources/Prior-Authorization-and-Pharmacy/
  • Pharmacy information including the formulary http://www.premierhealthplan.org/Providers/Provider-Resources/Prior-Authorization-and-Pharmacy/
  • Behavioral Health resources
  • Provider directory
  • Provider newsletters http://www.premierhealthplan.org/Providers/News/Provider-Brief-Newsletter/
  • Notice of privacy practices
  • Quick Reference Guide http://www.premierhealthplan.org/Providers/Provider-Resources/Prior-Authorization-and-Pharmacy/
  • Medical Management services http://www.premierhealthplan.org/Providers/Provider-Manual/Medical-Management/
  • Provider OnLine for access to claims information http://www.premierhealthplan.org/Providers/

If your office does not have access to this information, please contact Provider Services at (855) 514-3678 to obtain these documents in print.

Key Contacts

The following charts include important telephone and fax numbers listed in the Provider Manual. Before calling Provider Services, please have the following information available:

  1. Provider's tax identification (ID) number (preferred), or
  2. Provider NPI number

Providers will also be asked for the member's identification number, if applicable.

Contact

Telephone Number

Provider Services
Eligibility inquiries, claims inquiries, claim appeals information

(855) 514-3678(855) 514-3678

PHG Provider Enrollment Specialist, in Provider Relations Department
Notification of provider additions, terminations, address changes, contracting or credentialing inquiries 
(Please note: Claims inquiries cannot be handled by the PHG Provider Relations Department. Please call Provider Services.)

(937) 499-7441(937) 499-7441
Email: PHG@PremierHealth.com

Medical Management 
To obtain prior authorization, or assistance with patient admissions/discharges

(855) 869-7140(855) 869-7140

Care Advisor
To speak to a Care Advisor or refer a patient for Care Advising Services

(855) 514-3678(855) 514-3678

Provider OnLine
For technical issues related to the provider portal or login

(855) 222-1043(855) 222-1043

Member Services
Premier Health Employee Plan

For member inquiries

(855) 869-7139(855) 869-7139
TTY: (855) 250-5604(855) 250-5604

Member Services
Premier HealthOne Plan 

For member inquiries

(855) 572-2159(855) 572-2159
TTY: (855) 250-5604(855) 250-5604

Member Services
Premier Health Business Value Plan 

For member inquiries

(855) 572-2160(855) 572-2160
TTY: (855) 250-5604(855) 250-5604

Member Services 
Premier Health Advantage Plan 
For member inquiries

(855) 572-2161(855) 572-2161
TTY: (855) 250-5604(855) 250-5604

Premier Health Plan Vision Network
Premier Health Advantage, Premier Health Advantage VIP and Premier HealthOne under the age of 19

(855) 514-3678(855) 514-3678

Pharmacy Services
Premier Health Employee Plan and Premier Health Business Value Plan 

(855) 266-0713(855) 266-0713

Pharmacy Services
Premier HealthOne Plan

(866) 822-2413(866) 822-2413

Pharmacy Services 
Premier Health Advantage

(866) 822-2714(866) 822-2714

Behavioral Health Services
Provided by Optum Behavioral Health
Consult the Optum Behavioral Health Provider Directory for specialists in this field 

Optum Customer Service:
(877) 218-7136(877) 218-7136

Fraud, Waste and Abuse
Call anonymously and without fear of retribution if you identify or suspect fraudulent activities or behaviors

(855) 222-1046(855) 222-1046

Vendor Contacts

Contact

Telephone Number

Behavioral Health Services: Optum Behavioral Health
Consult the Optum Behavioral Health provider directory for specialists in this field

Optum Customer Service: (877) 218-7136(877) 218-7136

Dental and Vision: Avesis
Providers bill Avesis directly.
Dental and Vision Providers must be contracted with Avesis. Please contact Avesis if interested in becoming a participating provider.

Avesis Premier Health Advantage Member Services:

(855) 704-0439(855) 704-0439

Avesis Pediatric Vision and Dental Member Services for Premier HealthOne and Premier Health Business Value Plans:
(855) 704-0438(855) 704-0438

OTC Supply Health Solutions (Over-the-counter supplies)
Premier Health Advantage VIP Only:

Member Services:
(844) 358-4459(844) 358-4459
Monday through Friday, 9:00 am to 5:00 pm  EST www.otchs.comOff Site Icon

Fitness Resource
Premier Health Advantage Only

(937) 223-5201(937) 223-5201 (phone)
(937) 223-3997 (fax)
For a complete list of facilities, please visit:
http://www.premierhealthplan.org/fitness/

Routine Transportation (Premier Health Advantage VIP Only): Med-Trans
Patients must coordinate through their Care Advisor

Member Services:
(800) 854-2137(800) 854-2137

eviCore healthcare (Radiology and Cardiology Advanced Imaging Benefit Management)

Phone: (844) 303-8449(844) 303-8449
Fax: (888) 693-3210
Website: https://www.evicore.com/healthplan/premier