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.
- 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.