Impacted: Health plan clients (commercial, Medicare, Medicaid)

What you need to know

Prime's operational teams are diligently preparing for the upcoming peak season and new plan year. Prime is requesting information from our clients to ensure we are ready on Jan. 1, 2027. The first deadline for walk-up submissions is Sept. 1, 2026.  

Overview 

A strong collaboration between Prime and health plan clients helps deliver a superior experience to you and your members. Thank you for your continued partnership as we prepare for peak season 2026.    

To help us best deliver on our commitments, Prime requires the below information from clients regarding benefits selections, Utilization Management (UM), member communications and more.   

Note: All information is required for these requests. If details are missing, these requests may not be completed by the effective date. 

Due Date

Action item

Sept. 1

Walk-up submissions for a Jan. 1, 2027, effective date are due to your Prime client account team.    Examples of walk-up projects include claim messaging updates, custom list changes, etc.

 

Oct. 1

UM program submissions for a Jan. 1, 2027, effective date are due to your Prime clinical program managers.

 

Nov. 13

Marketing requests are due in order for member letters to be delivered to members by Jan. 1, 2027. Note: Marketing requests must be accompanied by an approved member letter template and data file.

 

Dec. 1

All Jan. 1, 2027, effective commercial benefit plan submissions are due (unless contracted with a different date).    Post go-live communication changes to member marketing are due to Prime.

Dec. 15

Grandfathered Prior Authorization (PA) request submissions for Jan. 1, 2027, are due to the PA analyst team.

 

If a request is received after any due date listed above, Prime will complete it in the order in which they were received. Late requests are not guaranteed to be completed by Jan. 1, 2027.  

Questions

Reach out to your Prime account team representative.