Prime Health Services

What Prime Health Services does

Prime Health Services, Inc. is a privately held Tennessee-incorporated managed care company founded in 2001, headquartered in Franklin, TN, operating one of the largest non-risk-bearing Preferred Provider Organization (PPO) networks in the United States with over 700,000 providers and facilities across all 50 states. It is organized around a platform-plus-modules architecture: the PrimePPO Network is the core asset, wrapped by the proprietary Renovo technology platform for pricing, processing, and performance management, with add-on modules including PRIMEscheduling (appointment lifecycle), Prime Integrated Essentials (PIE, bundled PPO access plus no-cost bill review), Prime Telemed (workers' compensation telehealth, launched 2017), EDI Bridge (real-time claim repricing), and the Prime Corrections sub-brand for correctional facility medical bill containment.

The company serves five distinct verticals — workers' compensation, commercial group health, auto casualty, corrections, and Medicare Advantage — selling to insurance carriers, third-party administrators, self-insured employers, governmental entities, and captive insurance organizations. Revenue is generated primarily through recurring network access fees, managed services (bill review, claims repricing), and technology platform licensing bundled into multi-year customized contracts. Distribution combines a direct enterprise sales team (National Sales Executives, VPs of Business Development, VP Strategic Relationships) with channel and technology partners including First Health (Aetna), Sana, WLT Software, LexisNexis Risk Solutions, and 4L Data Intelligence.

Growth has been driven by a multi-decade acquisition cadence (Applied Metrics 2011, CoreChoice 2011, Coastal Comp 2011, Casualty Management Network 2012, InterWest Health 2021, InterGroup Services 2022), strategic partnerships, and product extension, supported by $8M in growth capital from LongueVue Capital in 2014. The company holds NCQA and URAC accreditations, is led by founder/CEO Brian Sharp, and continues to expand its executive bench (CRO, COO, COO, CPO appointments across 2018–2026).

Name

Prime Health Services

Legal name

Prime Health Services, Inc.

Website

https://primehealthservices.com

Company type

Private

Founded year

2001

Operating status

Operating

Headcount range

51–100 employees

Short description

Prime Health Services operates one of the largest non-risk-bearing PPO networks in the United States, with over 700,000 providers across all 50 states, serving insurance carriers, TPAs, employers, and government entities in workers' compensation, group health, auto casualty, corrections, and Medicare Advantage markets via its Renovo technology platform.

Ownership category

akta.pro rank

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Services-Misc Health & Allied Services, Nec (8090), Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

National PPO Networks (HLAEANAA)

akta.pro secondary industries

Workers’ Compensation PPO Networks (HLAEANAH), Auto/No-Fault PPO Networks (HLAEANAI), Regional & Local PPO Networks (HLAEANAB), MA PPO Plans (Local/Regional PPO) (HLAEACAB)

Keywords

• PPO network management
• Healthcare cost containment
• Workers compensation services
• Medical bill review
• Provider network access

Headquarters

HQ city

Brentwood

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. PPO Network Access: Provides access to the PrimePPO Network consisting of over 700,000 providers and facilities. Revenue generated through network access fees charged to insurance carriers, TPAs, self-insured employers, governmental entities, and captive insurance organizations for workers' compensation, commercial group health, auto liability, corrections, and Medicare Advantage markets.
2. Bill Review Services: Included at no added cost for primary PPO clients (Prime Integrated Essentials), with separate bill review services available. Provides claims hygiene, coding verification, and pricing accuracy review.
3. Technology Platform Licensing: Renovo platform and PRIMEscheduling tools offered as part of comprehensive cost containment solutions. May be offered as standalone or bundled technology services.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels7 records

Core offering

Prime Health Services operates one of the largest non-risk bearing PPO networks in the United States with over 700,000 providers and facilities across all 50 states. The company provides customized PPO network access, medical bill review, claims repricing, telemedicine, and proprietary technology solutions (Renovo platform, EDI Bridge, PRIMEscheduling) for workers' compensation, group health, auto casualty, corrections, and Medicare Advantage markets.

Product overview

Prime Health Services operates as a PPO network provider offering a platform-plus-modules architecture centered on its Renovo technology platform and PrimePPO Network. The core offering combines a national PPO network (700,000+ providers) with integrated technology solutions including Renovo (all-in-one pricing/processing/performance platform), Prime Integrated Essentials (PIE - bundled PPO + bill review), PRIMEscheduling (appointment management), Prime Telemed (telemedicine), and No-Cost Bill Review. The company serves workers' compensation, group health, auto casualty, corrections, and Medicare Advantage markets through both direct offerings and sub-brands like Prime Corrections.

Differentiator

Problem solved

Functional benefit

Brands

• Renovo: An all-in-one technology platform for managing pricing, processing, and performance across healthcare markets, with customizable tools for enhanced efficiency and cost reduction.
• PRIMEscheduling
• Prime Integrated Essentials (PIE)
• Prime Corrections
• Prime Telemed

Quantifiable outcome

• Claims processed and paid in average of 14 days
• +3 more outcomes

Named customers6 records

Segments5 records

Ideal customer profiles3 records

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

AI capability2 records

Feature5 records

Partnerships

Seven partnerships are on record, tiered major and core.

• Badger State Sheriffs' AssociationmajorGTM or Marketing Partner · 5 August 2025Preferred vendor partnership establishing Prime Corrections as preferred vendor for Wisconsin sheriffs to support containing and managing offsite inmate medical care costs. Services include medical bill review, clinical review, Medicare benchmarking, and negotiated discounts.
• 4L Data IntelligencecoreTechnology or Integration · 7 July 2025Partnership to enhance AI-driven fraud, waste, and abuse detection using advanced risk scoring and real-time behavioral analytics. Addresses healthcare fraud detection market projected to reach $17.83 billion by 2030.
• LexisNexis Risk SolutionscoreTechnology or Integration · 17 October 2023Collaboration for provider data management including data cleansing, enhancement, ongoing monitoring, and maintenance. Addresses provider data accuracy, sanctions tracking, provider status updates, group affiliations, license numbers, taxonomies, and CMS specialty codes.
• SanacoreStrategic or Co-development Partner · 12 April 2023Strategic partnership to expand coverage to a larger number of individuals, increasing provider locations in Sana's network from 1.2 million to 1.7 million (over 40% increase). Prime Health Services is particularly strong in 80% of states where Sana operates. Sana customers can discover providers in the Prime Health network through Sana's internal Find Care tool.
• First Health (Aetna subsidiary)majorChannel Partner/ Reseller/ Distributor · 22 October 2019Partnership to offer PRIMEpon (physician-only network) nationwide to First Health's clients. Prime Health developed established network of allied providers to steer patients to appropriate sites of care.
• WLT SoftwaremajorTechnology or Integration · 21 December 2017Partnership providing WLT's clients access to Prime Health Services' national network of medical providers. EDI bridge interface enables real-time claim repricing with thousands of bills processed in days rather than weeks.
• Consumer Health Connections (CHC Telehealth)coreTechnology or Integration · 19 July 2017Strategic partnership with CHC Telehealth for cloud-based telehealth technology platform customized for workers' compensation industry. CHC provides virtual care system with video/audio communication and reporting capabilities.

Scale indicators13 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• MultiPlan: Largest independent PPO network and cost-containment vendor in the U.S., serving payers, TPAs, employers, and government plans with network access, repricing, and analytics — directly comparable to Prime's PrimePPO Network across workers' comp, group health, and auto casualty.
• Zelis: Healthcare cost-management and payments platform offering network access, claims cost containment, and analytics — a direct competitor across Prime's core PPO, bill-review, and payment-integrity verticals, including the workers' comp and group health markets.
• HealthSmart: Independent PPO network and healthcare cost-containment company serving self-funded employers, TPAs, and carriers — direct competitor in PPO access and claims repricing across group health and workers' compensation.
• CorVel Corporation: Public managed-care company providing PPO networks, bill review, case management, and utilization review primarily to workers' compensation and auto liability payers — directly comparable to Prime's WC and auto casualty verticals.
• Three Rivers Provider Network (TRPN): National PPO network providing medical provider access and managed-care services for workers' compensation, group health, auto, and corrections — a closely comparable non-risk-bearing PPO peer across Prime's primary verticals.
• USA Managed Care Organization: Specialty managed-care organization providing PPO networks, utilization review, and bill review for workers' compensation and auto liability markets — a focused competitor to Prime in WC and auto casualty.

Broad incumbents

• Enlyte (formerly Mitchell International): Property & casualty technology and services firm offering bill review, PPO networks (Coventry), and claims management — competes with Prime in WC and auto while also being a channel partner ecosystem (WLT Software / Mitchell adjacencies).
• First Health (Aetna/CVS): Aetna-owned national PPO network serving group health and workers' comp clients — both a competitor in PPO access and an existing Prime channel partner (PRIMEpon distribution); comparable offering but with payor-owned economics.
• Anthem / Carelon Health (Cofinity PPO): Major carrier-affiliated PPO network (Cofinity) serving group health and workers' comp — a payor-owned competitor with deeper rate-negotiation leverage in network contracting.

Others

• LexisNexis Risk Solutions (Healthcare): Provider data management and analytics vendor — both a current Prime integration partner (provider data cleansing) and an enabler to other PPO peers; relevant as an ecosystem participant shaping provider directory accuracy.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat7 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/PrimePPO
• Facebookfacebook.com/primehealthservices
• LinkedInlinkedin.com/company/prime-health

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Subsidiaries1 record

Funding overview

Funding rounds1 record

Investors1 record

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A5 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Prime Health Services