Specialized Care Not Available in Primary Coverage Areas

The Prominence Health Plan Centers of Excellence Program offers a continuum of care for patients with complex healthcare needs. Our Medical Management team works directly with the member’s provider to determine the most effective, safe and affordable care at a Center of Excellence (COE) for complex conditions.

A 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.

COE Program Highlights

  • 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 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 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.
  • Members may be eligible for travel benefit reimbursement.

Members will coordinate health services at a COE through their provider who will partner with the Prominence Medical Management team to determine the most beneficial path for effective care.

Centers of Excellence Program

Specialized Care Not Available in Primary Coverage Areas

The Centers of Excellence Program was created to offer a continuum of care for patients with complex healthcare needs. The Prominence Health Plan Medical Management team works with the member’s provider to determine the most effective, safe and affordable care at a Center of Excellence (COE) for complex conditions.

A 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.

Centers of Excellence medical categories include: Complex Cardiac Care, Complex Cancer Care, Neurology and Rehabilitation, and Organ or Tissue Transplants. Not all complex or specialized procedures within these categories require the use of a COE. The use of a COE is directed through the Medical Management prior authorization process.

Things to Know Before Accessing a COE

  • 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 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.

Please contact Customer Service with any questions.

* 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.

Center of Excellence Locations

Cancer Care
  • Huntsman Cancer Institute
    Salt Lake City, Utah
    Carson City, Nevada
  • Southern California Gamma Knife Center at San Antonio Community Hospital,
    Upland, California
Cardiology
  • University of Utah Health Care
    Salt Lake City, Utah
Neurology and Rehabilitation
  • University of Utah Health Care
    Salt Lake City, Utah
Organ or Tissue Transplants

Tethys Transplant Network, which includes:

  • Stanford Hospital
    Stanford, California
  • Children’s Hospital of Oakland
    Oakland, California
  • UC Davis Medical Center
    Sacramento, California
  • University of Utah Medical Center
    Salt Lake City, Utah
Centers of Excellence