Inmate Medical Cost Management Program
Simple Process. More Savings.
The Inmate Medical Cost Management Program (IMCMP) provides cost containment services for all off-site medical procedures including x-ray, dental, optical, inpatient hospital and outpatient visits. This program is an enhancement to on-site medical care and does not carry an enrollment fee. Participants only pay for the service if savings are achieved. A portion of the savings goes toward payment for the negotiation and the detailed review of medical bills.
While the average savings are 35% to 40%, this network can provide up to 80% in savings. To understand how significant the savings can be, one Florida Sheriff's Office asked us to review a bill that was several years old. After scrubbing the bill, the Sheriff received a 59% reduction in the total billed amount. In another instance, the program was able to negotiate a 51% reduction on a bill for an inmate who was treated at an out-of-county trauma center.
Nationwide Corrections Network
The IMCMP provides access to a nation-wide network of directly contracted medical providers. This nationwide corrections network includes 597,216 providers, 2,971 hospitals, and 126,254 facilities.
Prime Health's state of the art software is equipped to adjudicate medical claims according to the Center for Medicare and Medicaid Standards (CMS) to assure that only appropriate claim charges on bills are reimbursed. Individual edits are performed at the detail claim line level and include industry standard edits such as: unauthorized / inappropriate services, incomplete claims, invalid or excessive codes, and unbundled charges.
PHS accesses its proprietary repricing system which has the ability to fully integrate our deeply discounted PPO network, as well as real time negotiations, and apply those to the medical claims. Our repricing services are performed onsite at PHS and our system allows for timely processing of bills and administrative efficiency. Upon each completed processed claim, we will provide you a summary showing medical services provided and discount received.
Prime Health Services will provide you with reporting to fit your specific needs. Our capabilities range from basic savings reports to most frequently occurring injuries, or other data specific to your inmate incident mix. We are happy to build any reports that you feel will help you analyze your program.
Negotiations & PPO
Once a claim has been scrubbed for accuracy, Prime Health Services applies a discount based on the contract held between PHS and the provider. If a current contract does not exist, our professional negotiations team will negotiate directly with the provider to achieve the deepest possible discount for the county jail. Through either the PPO or the negotiations channel, counties stand to receive some of the best discounts available to the industry.
A toll-free number is provided to the county jail for the purpose of calling to authorize the inmate for offsite medical treatment. Pertinent information is taken at this time to ensure that the county jail is only responsible for medical services during the inmate's incarceration. Medical claims are only processed and paid if the inmate was in custody at the time of service.