Skip to content Specialized care programs are structured services that help patients who need regular follow-up. These programs create a coordinated plan to track lab results, adjust medications, and coordinate referrals for better treatment.
Prime Health United manages these programs end-to-end so patients receive consistent care and practices gain sustainable revenue.
Chronic diseases drive nearly 90% of U.S. healthcare costs, with 6 in 10 adults managing at least one chronic condition and 4 in 10 living with two or more. These patients need regular follow-up, medication management, and preventive monitoring for consistent care.
Prime Health United will run your specialized care programs so that results are steadier, healthier, and stronger. Generating a more predictable revenue stream for your practice.
Prime Health United runs care programs recognized by the Centers for Medicare & Medicaid Services (CMS). We help you improve patient outcomes and create steady reimbursement for practices.
Supports patients with two or more chronic conditions. We handle monthly check-ins, care plan updates, and documentation so CCM codes can be billed without gaps.
For patients with multiple high-risk conditions. We coordinate at least 60 minutes of structured care each month to meet billing requirements for complex patients.
Focuses on a single serious condition. We manage the monthly touchpoints and records so providers can bill PCM services accurately.
For the adult needs of your specialty services, PHU will deliver the remote patient monitoring through connected devices. We track and log results in the EHR to meet the highest quality and control standards.
Brings together primary care, behavioral health, and psychiatric consultation through a structured, team-based model and shared plans so CoCM codes are supported.
Integrates mental health with primary care. We document 20+ minutes of management for conditions like depression or anxiety, and bill details accurately.
Prime Health United grows with you. As your patient panel expands, our percentage share steadily decreases, which means you keep more of the revenue.
There are no complicated or hidden rules. The larger your practice becomes, the more favorable your rate.
We use a payment model built around the number of patients. As your patient panel grows, Prime Health United’s share decreases, so you keep more of the revenue.
| Tier | Patient Count | PHU Share | Your Share |
|---|---|---|---|
| Tier 1 | Up to 100 | 50% | 50% |
| Tier 2 | 101–200 | 48% | 52% |
| Tier 3 | 201–400 | 46% | 54% |
| Tier 4 | 401–700 | 43% | 57% |
| Tier 5 | 701–1000 | 39.5% | 60.5% |
| Tier 6 | 1000+ | 35% | 65% |
Note: For tier calculations, each program enrollment counts separately (e.g., if one patient is in two programs, they are counted twice). This ensures fair alignment between service usage and revenue sharing.
For every practice you refer to PHU, your share increases by 1%, and that practice will also start with a 1% advantage.
For Example, if you are in Tier 2 (150 patients), Prime Health United’s share is 48% (your share: 52%). After you refer another practice to PHU, PHU’s share for you drops to 47% (your share: 53%).
Suppose your referred practice is in (Tier 1), instead of the standard 50%/50% split in Tier 1, they begin at 49% PHU / 51% practice.
Note: Only one type of discount applies at a time. Either your tier rate or your referral reward.
We keep the process straightforward; every step is sequenced to meet CMS rules, reduce holds, and generate reliable reimbursements. From identifying eligible patients to delivering monthly revenue reports, the workflow is clean, auditable, and smoothly integrated into your EHR.
Patient Enrollment & Eligibility
We confirm program eligibility and secure patient consent, embedding all documentation directly into your EHR.
Program Setup & Care Coordination
We build structured care plans, schedule follow-ups, set communication triggers, and onboard RPM devices if used.
Monitoring, Communication & Documentation
Every interaction is logged, including vitals, symptom tracking, and care plan updates. Required care time or device-data thresholds are tracked.
Billing, Compliance & Reimbursements
We prepare complete documentation aligned to specific codes to ensure compliant claims and reduce denials.
Ongoing Reporting & Revenue Growth
You receive actionable reports on enrollment, activity, billing, and outcomes that help your team actively grow programs and sustain revenue.
Care programs often face delays when requirements like documented consent and data threshold aren’t consistently met. Prime Health United manages every part of the process. We handle patient eligibility, consent, care activities, documentation, and billing preparation to ensure your reimbursements arrive on time.
No. A single practitioner cannot bill both. However, different practitioners may bill CCM and PCM for the same patient if they are treating different conditions with separate care plans.
CoCM is team-based (comprising a billing practitioner, behavioral health care manager, and psychiatric consultant) with defined monthly minutes and registry-driven reviews; a Primary Care Practitioner leads general BHI and involves integration with ≥20 minutes/month.
It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using ‘Content here, content here’, making it look like readable English.
Optimized by Seraphinite Accelerator