PHS - Community Providers


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	Welcome to PHS' Community Provider page. This page provides information to our many community partners who work with us to provide quality health services to inmates in our care. Please see below for frequently asked questions and answers regarding the provision of services for a PHS patient and the reimbursement process.
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	Do I need an authorization for services to be provided?
	Yes. Authorization for specific services will be obtained by the correctional institution before the inmate is scheduled for their appointment. When the appointment is made the correctional institution should be able to provide an authorization number for your records. Any questions regarding the authorization should be directed to the medical staff at the referring correctional institution. When the inmate arrives for their appointment an authorization letter should be provided to you by the correctional officer. If you do not receive the authorization letter at the time of the appointment, contact the correctional institution from which the patient has been referred. Services must be authorized before the claim can process and payment can be made; however, authorization does not always guarantee payment. *Please place the authorization number on the claim form in box 23 of the CMS 1500 and box 63 of the UB-04.*
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	Where do I send the claims?
	Claims for services covered by PHS should be submitted within 60 days (unless otherwise specified in any Agreement you may have with PHS) from the date of service to the following address to insure timely filing and prompt payment:
	Prison Health Services Attn: Claims 105 Westpark Drive, Suite 200 Brentwood TN 37027	(Please note that sending claims to the correctional institution or any other address will delay the processing and reimbursement and could potentially result in lost claims and non-payment of services.)
	Claim submissions should be in accordance with AMA and CMS guidelines for billing. Claims should be submitted on the CMS 1500 form. The form should be completed to the same extent as they are with commercial insurance payers. The patient address as well as the Insured’s address will be the correctional institution address. The payor name will be Prison Health Services.
	Non-contracted providers that have not previously submitted a claim to PHS should include a completed W9 form (click here for W-9 Form) with their first claims submission. The W9 is necessary to ensure that the correct remit address and tax identification number are entered into the PHS system so the claim can process and timely payment can be received.
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	How do I check status on a claim I have submitted?
	Questions regarding the status of a submitted claim may be directed to: Customer Service at 888-865-2910 OR E-mail: claimscustomerservice@asgr.com When calling or emailing for claim status please have the Provider’s tax identification number, the inmate’s full name, date of service, and amount of the claim ready. Providers contracted to provide service for PHS may utilize our internet provider inquiry system to check status of their claims. If you are a contracted provider but do not have access to the internet provider inquiry system, please send an email to: claimscustomerservice@asgr.com to obtain more information.
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	What if I have questions or concerns regarding the reimbursement I received on my claim?
	Questions regarding the reimbursement received on a claim should be directed to: Customer Service at 888-865-2910 OR E-mail: claimscustomerservice@asgr.com If the provider feels their claim has not processed correctly they should submit their initial grievance in writing no later than ninety (90) days following the receipt of the payment or denial. The initial grievance should detail the date(s) of service, patient name, amount paid and the amount in dispute. The grievance should be mailed to: Prison Health Services, Inc. Attn: Grievance Coordinator 105 Westpark Drive, Suite 200 Brentwood, TN 37027 The grievance will be investigated and a response given within 45 days. If payment or denial is accepted and no grievance is filed within the ninety (90) days following the payment or denial, PHS considers the matter to be final. PHS reimburses non-contracted providers at rates similar to state and federally funded payors.

	Should payment be denied for services by the PHS Utilization Review Department, Hospitals may request reconsideration by submitting a written request with supporting documentation within 45 days of the dated letter of payment denial. A response will be given within 45 days. Requests should be mailed to:
	Prison Health Services Attn: Medical Review Committee c/o Utilization Management 105 Westpark Drive, Suite 200 Brentwood, TN 37027
	Questions regarding the meaning of denial codes seen on the Explanation of Benefits (EOB), may be answered by clicking here.
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	Is there anything else I need to know about providing services to a PHS patient?
	PHS patients are incarcerated at the time of service; therefore, Providers shall make no attempts to obtain additional payment from the patients or other parties for services that PHS is responsible for or has already paid the Provider. The fees paid by PHS represent payment in full for services rendered. Under no circumstances should Medicare or Medicaid be billed for an inmate’s care with exception of some inpatient services provided in Vermont and Michigan, which these state Medicaid programs may cover. The inmate’s paperwork or the medical staff at the facility will assist Providers in identifying services that fall into either of these two categories.
	All clinical information including recommendations for additional services and follow-up appointment(s) should be supplied to the Correctional Officer accompanying the patient or to the medical staff at the referring correctional institution, never to the patient. Any additional patient information that may be needed can be obtained by contacting the medical staff at the referring correctional institute.