PruittHealth Premier is implementing new platforms for the 2024 plan year to continue elevating your experience as a provider working with our plan. We wanted to take this opportunity to share how these important changes will impact you. Below are commonly asked questions, if you have additional questions please contact plans contact center for additional information.
Frequently Asked Questions (FAQs)
Important Information: When submitting Professional Claims with Dates of Service spanning from 2023 to 2024 the claim must be split. 2023 Dates of Service must be submitted to legacy claims address or payor ID. Please see below for updated 2024 claims address and payor ID information.
Will there be a new Member ID card?
Yes, members will receive new ID cards for the 2024 plan year.
Will there be a new Member ID number?
New ID numbers will be assigned to new enrollments effective 1/1/2024 and forward. Members enrolled prior to 1/1/2024 will continue to use their existing Member ID Number.
Will there be a new paper claims mailing address?
Yes, please update your records PO BOX 785 Glen Burnie, MD 21060-0785
PruittHealth Premier strongly encourages electronic EDI claims submissions.
Will there be a new clearing house?
Yes, the Medical claim clearinghouse is changing to Availity. Submit claims for
PruittHealth Premier of the Carolinas (NC and SC) H6345 to PHPC1
PruittHealth Premier (GA) H3291 to PH001
Will there be a new payor ID?
Please see question above for applicable plan Payer ID.
Will there be a change in the pharmacy BIN, PCN or Group number?
No, Pharmacy and Part D platforms are not migrating.
Will there be a new claims portal for 2024?
Yes, effective 1/1/2024 there will be a new provider portal accessible from https://pruitthealthpremier.com/providers/2024updates.
How do I gain access to the new Provider Portal?
Self-Service portal registration will occur through the portal accessible from https://pruitthealthpremier.com/providers/2024updates.
I already have a Provider Portal and/or EZ-Net Portal account. Can I use my existing login credentials to access the new Provider Portal?
No, you will need to register for a new Provider Portal Account by clicking on “Create Account” on the new Provider Portal’s login page, which is listed at the top of this page titled “Provider Portal Login”
Will all historical information be shown in the new 2024 portal?
No, only information for dates of service 1/1/2024 and forward will be available through the new portal.
How can 2023 and past claims information be seen?
Access to historical information will continue to be accessible through existing channels during 2024.
Will there be a change to how I received payments for 2024 and forward dates of service?
Please refer to the Payment Enclosure for the actions you may need to take for 2024 Date of Service Payments. The payment process for 2023 Date of Service Claims is not changing.
If I have a claim for Date of Service 2023, were do I submit it?
No change, please continue to use current EDI or paper claims submission.
If I have a claim that has split dates of service spanning from 2023 to 2024, how do I submit it?
Please submit claims to new 2024 information of which is listed above.
Will there be changes to how capitation is paid?
Yes, capitation will be paid through the same processes as fee for service claims. Please refer to the payment enclosure for instructions on how to enroll your payment preferences.
Will there be a new portal to submit authorizations for 2024?
Yes, effective 1/1/2024.
Is there a cutoff for submitting authorizations on legacy portal?
Legacy portal will have limited functionality starting 12/11/23. Providers will NOT be able to submit authorizations via portal from 12/11/23-12/31/23.
How can authorization be submitted during portal blackout period from 12/11/23-12/31/23?
Authorizations can be submitted via fax to 833-610-2399 or email at [email protected].
During blackout period can the portal still be accessed?
Yes, the portal can still be accessed with limited functionality.
If an authorization is submitted via fax or email during blackout period, can it be seen on the existing legacy portal?
Yes, authorization can be seen on portal.
Can I see previous years authorization information in the new 2024 portal?
No, for previous information please contact plans Contact Center at:
1-855-855-0668 PruittHealth Premier
1-855-855-0759 PruittHealth Premier Carolinas
Will a previously approved authorization spanning from 2023 to 2024 be affected?
The authorization will be split up by dates of service into both systems to allow claims to process seamlessly.