Premera accepts electronic claims and inquiry/request transactions either by direct submission or from selected clearinghouses.
Sending electronic claims and inquiry/request transactions offer several advantages:
You can send electronic claims and batch inquiry/request transactions directly to Premera (if you don't use a clearinghouse) through our Secure Transport service. Secure Transport allows the transfer of files through a secure internet connection. It's a proven solution for the reliable delivery of both large and small files.
With our Secure Transport service, you can:
Access to Secure Transport is available through our EDI enrollment process. For more information, call our EDI Team at 800-435-2715.
Premera accepts claims for the following:
The following claim types may be billed electronically:
Currently, PBC uses ANSI 837 Healthcare Claim ASC X12N Version 4010A1 for the claim types:
Note: ANSI 837 Healthcare Claim ASC X12N Version 5010 will be mandated for use on June 30, 2012.
The EDI (Electronic Data Interchange) process will return a 997 (Functional Acknowledgement transaction) and Electronic Claims Transaction Reports to the submitting entity. For more information about 997s see HIPAA/EDI FAQ.
Electronic Reporting provides the following:
A corrected/replacement claim is any claim that has changes or corrections to one of the following:
Providers should submit a corrected or replacement claim electronically using the HIPAA 837 standard claims transaction, and include the following information:
A free-form note with an explanation for the Corrected/Replacement Claim, in Loop 2300 'Claim Note', as:
For Professional & Dental Claims, segment NTE01 must contain 'ADD' and segment NTE02 must contain the note, Example: NTE*ADD*CORRECTED PROCEDURE CODE
For Institutional Claims, segment NTE01 must contain 'UPI' and segment NTE02 must contain the note, Example: NTE*UPI*CORRECTED LAB CHARGES
Telephone: 800-435-2715 option 1
Telephone: 800-435-2715 option 2
Telephone: 800-435-2715 option 3
Premera Blue Cross
P.O. Box 327
Mail Stop 481, EDI
Seattle, WA 98111-0327
Premera Blue Cross
Mail Stop 481
7001 220th Street SW
Mountlake Terrace, WA 98043-2124