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Centers of Excellence Program2018-08-27T09:13:32+00:00

Centers of Excellence Program

FOR SPECIALIZED CARE NOT AVAILABLE IN PROMINENCE HEALTH PLAN PRIMARY COVERAGE AREAS

A Center of Excellence (COE) is a healthcare facility or practitioner that provides highly specialized care to members with certain health conditions, while meeting Prominence Health Plan’s high standards for quality and value. COE partner facilities must demonstrate rigorous quality control measures, positive patient outcomes and cost-efficient healthcare delivery.

The Centers of Excellence program was created to offer a continuum of care for patients with complex health care needs. Through a collaborative approach, the PHP Medical Management team works with a Health Plan member’s provider to determine the most effective, safe and affordable care at a Center of Excellence for complex conditions.

Centers of Excellence medical categories include: Complex Cardiac Care; Complex Cancer; Neurology and Rehabilitation; and Organ or Tissue Transplants.

Not all complex or specialized procedures within the COE categories require the use of a COE. The use of a COE is directed through the Medical Management prior authorization process.

Things you need to know before accessing a COE

If you have questions, please contact Customer Service.

  • Members must be pre-approved to use a designated COE facility or practitioner.
  • Designated COE providers may be located out of Prominence Health Plan’s primary service area, members may be eligible for travel benefits of up to $3,000 per trip*.
  • Members are required to use COE facilities approved for specific medical conditions or surgical procedures; a non-COE facility may be pre-approved by Prominence Health Plan’s Medical Management team if a COE facility is unable to provide the required services.
  • Use of a non-COE facility for designated conditions will result in benefits being paid at the out-of- network level and a much higher member expense unless the use of a non-COE facility has been pre-approved by Prominence Health Plan’s Medical Management team.
  • Standard prior authorization requirements still apply.

* Includes lodging/meals at $200 per day, up to a maximum of $2,000 per trip. Airfare/rental car or personal vehicle mileage at $1,000 maximum per trip. $10,000 annual limit on all eligible travel expenses.

Centers of Excellence

CANCER CARE

Huntsman Cancer Institute, Salt Lake City, UT & Carson City, NV
Southern California Gamma Knife Center at San Antonio Community Hospital, Upland, CA

CARDIOLOGY

University of Utah Health Care, Salt Lake City, UT

NEUROLOGY & REHABILITATION

University of Utah Health Care, Salt Lake City, UT

ORGAN OR TISSUE TRANSPLANTS

Tethys Transplant Network, which includes
Standford Hospital, Stanford, CA
Children’s Hospital of Oakland, Oakland, CA
UC Davis Medical Center, Sacramento, CA
University of Utah Medical Center, Salt Lake City, UT