BlueCard Alert®: Prime Healthcare Member Required Authorizations for Care

May 6, 2020

Prime Healthcare’s employees and their dependents are covered by Blue Shield of California through our BlueCard program. When a Prime Healthcare member seeks emergency care at a Blue Cross and Blue Shield of Texas (BCBSTX) facility, you must contact Prime Healthcare for authorization of services once they are stabilized.

To obtain authorization from Prime Healthcare, contact:

Prime Healthcare Central UM
Phone 1-877-234-5227
Option 1, Inpatient Emergency Admission, Transfer or Discharge
Available 7 days a week, 24 hours a day

You can identify Prime Healthcare members by the Prime Healthcare logo and the three-character prefix “PHU” on their ID card.

Why is this important?

Prime Healthcare is a national health system with hospitals in 14 states. When Prime Healthcare members seek treatment outside of its network of facilities, it requires providers to seek authorization for post-stabilization care from Prime Healthcare Utilization Management.

According to Prime Healthcare, facilities not contracted with Prime Healthcare who don’t comply with their notification policy are prohibited by law from billing the patient for the cost of any post-stabilization care, unless the patient has accepted responsibility for the cost in writing. The facility may collect from the member, only his or her cost-sharing amount.

Checking eligibility and/or benefits information is not a guarantee of payment. The fact that a service has been prior authorized/pre-notified is not a guarantee of payment Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.