Our Services

To best serve our partners, providers and members, we provide a full range of eye care services, including Routine Vision, Medical & Surgical and Administrative Services. Our network of eye care providers, including optometrists, ophthalmologists, facilities and anesthesiologists, provide complete eye care services to the members of our Health Plan partners.

Routine Vision

Premier manages hundreds of unique vision plans for our partner Health Plans. Through our expansive network of ophthalmic physicians, we provide exams, eyeglasses and contact lenses to members insured by our Health Plan partners.

Routine comprehensive eye exams are vital to our overall health:

Our vision is important to our general health and well-being.
- 80 percent of what children learn is through their eyes
- Children have better academic success when their vision is fully developed
- As we age, our vision affects our balance – loss of vision may lead to falls with life changing impact
Routine comprehensive eye exams can detect not only vision problems and eye disease, but also general health problems, such as diabetes, hypertension and hardening of the arteries, before you are even aware that a problem exists.
Early detection of cataracts, retinal disorders, glaucoma and macular degeneration can help prevent vision loss or blindness.

Medical & Surgical

Premier delivers comprehensive medical eye care through contracted medical eye providers, from office exams to complex ocular surgical procedures.

Credentialed Premier providers must meet high standards. Ophthalmologists are eligible to be certified through the American Board of Ophthalmology, which awards certification to providers who meet a series of accredited medical training requirements in ophthalmology; pledge to practice with compassion, integrity and respect for human dignity, and complete an intensive evaluation process. Optometrists maintain high standards for quality, meeting the requirements to maintain their licensure and staying current with the latest standards of eye care.

As part of our shared dedication to excellence, Premier works with providers and Health Plans on a Medical Management Program for eye complications – retinal edema, cataracts, retinopathy, and others – related to diabetes. This reporting system adds a fifth digit sub-classification to the provider’s coding on claims, which provides the most accurate information about the complication and about the patient’s health to Health Plan partners.

Hedis^®

Our highly skilled team works with Health Plans and providers to manage and implement a robust program for HEDIS^® — Healthcare Effectiveness Data and Information Set — which has consistently delivered 4 and 5 stars on the eye-related indicator for our partners.

Administrative

Premier utilizes a variety of eye care management models to meet the needs of our partner Health Plans. Headquartered in Tampa, Florida with operations centers in Boca Raton, Florida and Honolulu, Hawaii we are a licensed Third Party Administrator. Premier is also NCQA certified in Credentialing and Utilization Management and accepts full Health Plan delegation for Claims Management, Provider Credentialing, Network Development, Member Services, Provider Appeals and Utilization Management.

License & Regulatory

Compliance in our heavily regulated industry must be 100 percent and Premier’s robust programs ensure compliance with all regulatory and accreditation standards. Our Health Plan partners depend on us to ensure that all state requirements are met, and that both the Plans and their providers are in full compliance. In turn, our Health Plan partners have peace of mind, along with streamlined audit processes.

Regulatory and licensing requirements vary from state to state. In addition to a certificate of authority, some states require a third-party administrator, utilization review organization and/or limited service health plan license. We hold the required certificates and licenses in each state where we conduct business. Our quality driven team who supports these efforts includes Directors who provide expert leadership in audit processes, claims, configuration, credentialing, finance, HEDIS^®, technology solutions, medical economics, network infrastructure and management, provider services, quality improvement and delegation, reporting and utilization management.

Premier is NCQA-accredited in Utilization Management and Credentialing. We credential each of our providers to ensure they meet all requirements to service Medicare, Medicaid, Healthy Kids, commercial and Exchange members. And as new regulations roll out or existing regulations change, our Health Plan partners depend on us to help them communicate those changes to providers.

What We Do