Managed Care that Works for Everyone
Prime Network Provider Spotlight

   About Us
Evolutions Healthcare Systems, Inc. Who is Evolutions Healthcare Systems (EHS)? EHS is one of the largest independently owned nationwide Preferred Provider Organizations (PPO). We contract with Hospitals, Physicians, and Ancillary providers to create a superior network of healthcare professionals that strive to deliver exceptional service at extremely competitive rates. Our state of the art claims management software, TRX-Transaction Re-pricing & eXchange architecture, has been designed to ensure timely and accurate claims processing. For additional information see About Us.

Does EHS have national network coverage? EHS provides access to more than 600,000 providers through our Prime Network, Prime Plus Network, Select Network, and Select Plus Network covering all 50 states, District of Columbia and Puerto Rico. Up-to-the-date information on specific providers may be obtained using our Provider Search.

Is EHS an Insurance Carrier or Third Party Administrator? EHS does not underwrite risk or administer health plans. To verify benefit information, contact your insurance company or plan administrator.

Who do I call to verify my benefit coverage and/or co-pay amounts? Evolutions Healthcare is a managed care company. We are not a health plan or an insurance company and do not pay health claims. As such, Evolutions Healthcare makes no determination regarding eligibility, benefits, or covered services. To verify benefit information, contact your insurance company or plan administrator.

My insurance administrator has not paid my medical claim, whom do I contact? In the event that no payment has been made on your medical claims, you will need to contact your insurance claim office or plan administrator for more information.

How can I verify if my healthcare provider (physician/hospital) is in the EHS network? To verify that a provider is in network, you can use our Provider Search and Custom Directory or contact Member Services.

My provider is not listed in the directory or is not in network. What should I do? To nominate a provider for the EHS network, simply complete our Provider Nomination form, or contact Member Services.

My provider is listed in the directory, but says he/she does not participate. What should I do? If you are visiting your provider and are informed that they are not in the EHS network, ask to use their telephone and contact Member Services. A Member Service Representative will gladly speak with the provider's staff to answer any questions.

My provider was listed in a previous directory, but not in the new directory. What does this mean? Participating physicians, hospitals and other providers are subject to change. It is very important to verify with your provider that your provider is still participating in our network prior to your visit.

I confirmed that my provider was in the EHS network, but at my next visit I was advised that they were no longer in the EHS network. What should I do? Because participating physicians, hospitals, and other providers are subject to change, you should contact Member Services to reconfirm that your provider is still participating in the EHS network. If your provider is no longer participating in EHS network, you can select another in-network provider.

Can I continue to see my provider even if he/she is no longer participating in the EHS network? You may continue to see your non-participating provider. However, this may affect your insurance benefits and co-pays. Please contact your insurance company or plan administrator for benefit information regarding out-of-network providers.

How can I get more information about Evolutions Healthcare Systems? If you would like to receive additional information please contact our Member Services Department