Provider Resources
As our provider partners, one of Prestige Health Choice's goals is to provide you the resources that you need in a clear, easy-to-find manner. In this section, you'll find items such as member benefit information, credentialing and prior authorization, and how to file a grievance or complaint.
Member information
Hospital resources
- Covered services guide
Guide for services covered by Prestige Expanded Benefits.
- Hospital discharge planning resource guide
Information that may be helpful in assisting with coordination and authorization as part of a discharge plan.
- Prior authorization
Information and processes regarding prior authorization for member treatment and services.
Other resources
- Behavioral health and substance use
Education and support for our network providers.
- Bright Start®
A maternity case management program providing prenatal and postpartum services.
- Care gaps
Find missing recommended services (care gaps) for your Prestige Health Choice members right on Availity.
- Clinical resources
Clinical practice guidelines and related information for providers.
- Credentialing
Provider credentialing through the Council for Affordable Quality Healthcare (CAQH).
- Cultural competency
Understand how to meet the cultural and linguistic needs of our members.
- EHR incentives/meaningful use
Electronic health records (EHR) overview for providers and healthcare professionals on the HealthIT.gov website.
- Forms
All the forms you need in one place.
- Healthy Behaviors programs
Information about programs that reward members for implementing healthy behaviors.
- Let Us Know program
A partnership with the provider community in the management of chronically ill members.
- Opioid overdose prevention
Opioid information from the Centers for Disease Control and Prevention (CDC).
- Pharmacy services
Drug formularies, pharmacy prior authorization process, and other pharmacy resources.
- Prestige analytics tool
Web-based reporting tool for physicians to review member medical services and HEDIS results. Read the analytics tool instruction manual (PDF).
- Prior authorization
Information and processes regarding prior authorization for member treatment and services.
- Provider appeals
How to dispute Prestige Health Choice's policies, procedures, or any aspects of Prestige Health Choice administrative functions.
- Provider manual (PDF)
Explore the latest provider manual, which now fully incorporates the claims manual.
- Quick reference guide
Access our Quick Reference Guide for important phone numbers.
- Zika virus benefits and policies
See coverage and benefit recommendations for the Zika virus.
If you have questions or require more information, call Provider Services at 1-800-617-5727 to speak to a representative.