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• 1.1.2025 5T Individual Comprehensive Formulary 25390

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• Provider Appeals

  Payment Appeal – A challenge or an ‘appeal’ related to benefit/payment denials by the Medicare health plan that results in zero payment being made to the non-contracted Medicare health plan provider. Examples include: Benefit Determinations Medical necessity issues Coverage issues related to nation and/or local coverage determination policies Claims Payment Dispute – Any decision…

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• National Resources

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• Privacy

  This Notice of Privacy Practices (NPP) describes how medical and claims information about you may be used and disclosed, how you can get access to your information, and your rights under HIPAA. Please review this NPP carefully. Feel free to share it with your family or personal representative. Click here to…

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• Web Disclaimer

  The benefit information contained within the PrimeTime Health Plan website is regularly updated to provide you with the most current information. While PrimeTime Health Plan strives to ensure the information contained on this site is accurate, we cannot guarantee benefits until we receive and process your claims.We maintain high standards…

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• Multi-language Interpreter Services

  Multi-Language Interpreter Services- Updated 9-18-23 English: We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at 1- 800-577-5084 (TTY 711). Someone who speaks English can help you. This is a free service. Spanish: Tenemos servicios de…

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• Careers

  PrimeTime Health Plan is a highly service-oriented insurance company.Are you an ambitious self-starter who wants a career with a top-ranked insurance company? If so, then AultCare is for you. Our average length of staff employment is more than ten years, which demonstrates the strong relationships we develop within the organization. With…

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• Interoperability

  Currently available to PrimeTime Health Plan Medicare Advantage Members and AultCare Marketplace Members. You may find a mobile app or computer program that requests access to your health information to help you monitor your personal health goals. As your health plan, we need to provide a way for you to…

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• Non-Contracted Provider Payment Appeals and Claim Disputes

  Payment Appeal – A challenge or an ‘appeal’ related to benefit/payment denials by the Medicare health plan that results in zero payment being made to the non-contracted Medicare health plan provider. Examples include: Benefit Determinations Medical necessity issues Coverage issues related to nation and/or local coverage determination policies Claims Payment Dispute – Any decision…

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• Prospective Member Webinars

  You must provide your mailing address to receive your free gas gift card. Gift cards are sent after the webinar and only if you reside in the service area. Please allow 4-6 weeks for gift card delivery by mail. PrimeTime Health Plan serves Carroll, Columbiana, Harrison, Holmes, Mahoning, Medina, Portage,…

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