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 Employee Plan insures Premier’s employees and families.

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 Southwest Ohio.

Sincerely,

Scott Swabb, DO
Medical Director
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 Management
  4. Claims Procedures
  5. Member Administration
  6. Pharmacy Services
  7. Vendor Management

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
  6. View Explanation of Payment (EOP) and member ID cards

To view information about an eligible member, providers need to log in 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 at http://www.premierhealthplan.org/Providers/Provider-Manual/.

Electronic Prior Authorization Submission

Premier Health Plan has the capability to accept prior authorizations submitted by providers electronically. Once submitted, providers are able to view the status of their request as well as make edits up until a decision has been rendered. 

If you are interested in obtaining access to submit requests electronically, please notify PHG@premierhealth.com to request permission. Requests will continue to be accepted via phone and fax as well.

Internet Site

The Premier Health Plan website is located at https://www.premierhealthplan.org/.

Physicians can find the following information on the website:

If your office does not have access to this information, please contact Provider Services at Telephone Temp: (855) 514-3678(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 for 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

(866) 721-8623(866) 721-8623 

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: 711

Pharmacy Services
Premier Health Employee Plan

(855) 266-0713(855) 266-0713 

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

Nurse Advice Line

(855) 677-6593(855) 677-6593

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