Sending electronic data interchange (EDI) transactions can help claims process faster and improve your cash flow.
The most common transactions are those mandated by the Health Insurance Portability and Accountability Act (HIPAA). Premera can exchange transactions with you directly or through a billing clearinghouse.
Claim payer IDs are used to make sure your electronic transaction is routed to the right health plan. If you're using a clearinghouse vendor, be sure to verify all payer IDs as they might request that you use a different payer ID than those listed here.
*These payer IDs work for all Premera plans, including Medicare Advantage, FEP, BlueCard, and NASCO.
We currently partner with many EDI clearinghouse vendors and often add news ones as requested. A clearinghouse acts as a go-between for the provider and the payer (health plan). Using a clearinghouse means you can reach multiple payers through a single vendor. Check with your clearinghouse for capability details on how to send claims to Premera. You can also submit your claims directly to us by uploading your claims and reviewing reports.
Before you enroll, you'll need to contact us to confirm that your system can send claims in the HIPAA-required format. Check with your system vendor about capabilities and then give us a call if you have questions at 800-435-2715 or email us. Once you've confirmed that your system is good to go, you can enroll by completing the EDI trading partner enrollment form. (Please call 800-435-2715 or email us and we'll send you the form.)
How will I know if my electronic claim was accepted or rejected?
We create an accept/reject report that we share with our direct submitters and clearinghouses. Check with your clearinghouse about receiving reports.
Make sure your National Provider Identifier (NPI) is noted on your electronic claims.
Premera accepts claim transactions for the following plans:
We accept electronic claims for out-of-state Blue plans through the BlueCard Program. You can submit your BlueCard claims with your regular transmission files to us, using the same payer ID, and we'll coordinate with the member's home plan. Be sure to include the three-letter alpha prefix when submitting BlueCard claims.View BlueCard alpha plan prefix list (login required). For more information, call our BlueCard team at 888-261-9562.
Premera also offers the following HIPAA transactions.
Please contact us for details on exchanging specific transactions other than claims.
You can submit a corrected, replacement, or voided claim electronically using the HIPAA 837 standard claims transaction. Please include the following information:
When sending us a secondary claim, please include the following required information:
If you have questions about billing these from your system, please contact your system vendor or clearinghouse.
Medicare note: When Premera is secondary to Medicare, there's no need to submit claims to Premera if your Medicare explanation of payment indicates the claim was forwarded (or crossed over) to the secondary payer. Submitting the claim to us will cause a duplicate.
BlueCard Program – Learn about electronic claims for out-of-state Blue plans.
Learn about electronic claims for out-of-state Blue plans.
Federal Employee Plan (FEP) – Learn about electronic claims for out-of-state Blue plans.
Use this website for FEP members in Washington and Alaska.
Electronic Funds Transfer (EFT) – Learn about electronic claims for out-of-state Blue plans.
Sign up for convenient, faster payments.
National Uniform Claim Committee (NUCC) – Learn about electronic claims for out-of-state Blue plans.
Learn about mapping from the 1500 claim form to 837.
National Uniform Billing Committee (NUBC) – Learn about electronic claims for out-of-state Blue plans.
Get additional institutional claim information.
OneHealthPort – Learn about electronic claims for out-of-state Blue plans.
View best practices for electronic transactions.
Phone: 800-435-2715Fax: 425-918-4234 (for EDI enrollment forms only)Email:EDI@premera.com
7001 220th Street SW
Mountlake Terrace, WA 98043-2124
If you need to submit paper claims, correspondence, or medical records, please mail to:
Premera Blue Cross
P.O. Box 91059
Seattle WA 98111-9159