Online Referral Form

Clients who already have a login and password to CIMS - Client Interactive Management System (Formerly ECAP), please login HERE.

Referral Requested By

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Claimant Information

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Claim Information

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Type of Claim

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PIP
Workers Comp
Liability
Disability
Other

Please explain:

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Service Requested

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Appeal
Audit
Bill Review
Code Review
Pre-Certification
 
Radiological Review
IME
Peer Review
(PRO) Peer Review
Case Management

Appeal

Audit

Radiological Review

Cervical
Lumbar
Other

Independent Medical Examination

Peer Review

(PRO) Peer Review

Case Management

Medical Case Management
One Time Assessment
Cost Projection
Telephonic Case Management

Provider Information

Attorney Information - Required If Attorney Involved With Claim

Additional Information

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Premier Prizm News and Resources

Premier Prizm News

As one of the nation's leading Medical Management firms, executives at Premier Prizm Solutions are a knowledgeable resource for members of the news media.
Premier Prizm Physician Network

Physician Network

If you would like to be considered for the Premier Prizm Solutions' Physician Network, fill out our form here:
Join Premier Prizm's Physician Network
Premier Prizm Career Opportunities

Career Opportunities

Premier Prizm Solutions is a company known for innovation in technology and superior customer service.