Individual Plan Tools and Resources

  • The individual plan website is managed by Evolent Health for Premera and uses tools specifically for patients with individual plans.

    If a member has an individual plan, their ID card will say Individual Plan. View an example member ID card.

    View prefix list for Individual Plans.

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    Note: Google Chrome is the best browser to use for the individual plan website.

    News and updates for individual plans

    Identifi
    You can submit a prior authorization for Premera Individual plan members using the Identifi online submission tool or you can fax the prior authorization form. Note there is a new code list.

    Access Identifi to submit a prior authorization request. Important: To prevent delays, check the prior authorization code list before submitting a request to see if review is required or should be submitted through AIM.

    It takes 1-5 business days to process your access to Identifi. If you need to submit a prior authorization during the waiting period, which automatically starts once you've clicked on the link to the Individual Plan secure provider portal, you can fax your submission or call our utilization management team. You can also call the customer service number on the back of the member ID card. You'll receive a confirmation email once you have Identifi access.

    Individual Prior Auth Tool Update

    As of June 28, 2021, care notes, phone numbers, and fax numbers are required fields on the Identifi prior authorization tool.

    Sending refund checks to Premera

    A form isn't needed for sending us refund (overpayment) checks. You can submit requests in writing and include the following related to the overpayment:

    • Member first and last name and ID number
    • Date of service
    • Amount and reason for refund
    • Primary explanation of payment (if related to coordination of benefits)

      Mail provider refund checks to:
      Premera Provider Refunds
      P.O. Box 840540
      Los Angeles CA 90084-0540

    New code list for 2021

    Effective January 1, 2021, individual plans will have prior authorization changes. To learn more, view Medical Policy & Coding Updates within the Special notices section or view the 2021 code list effective January 1, 2021.

    Secure website error message

    If you received the message, "You have successfully logged into the Evolent application, but we do not find the Provider," read these instructions to provide key services to your individual plan patients.

    Secure member eligibility search

    The member eligibility search doesn’t accept member prefixes. Search by member ID or by the member’s last name and date of birth for accurate results.

    CMS 1500 online claims submission not available

    The online claims submission tool for HCFA (CMS) 1500 claims currently isn’t available on the individual secure website. In the meantime, submit claims by mail to the address below or through Office Ally.

    For professional and institutional claims, the claim payer ID is 00430 and for dental claims the ID is 47570.

    COVID-19 prior authorization updates

    Check out our COVID-19 FAQ for the lasted updates on prior authorization.

    Training guides

    Use the following provider training guides to learn more about our individual plan tools:

    Provider resources

    Provider directory

    Search for medical providers, facilities, and other specialists within the Premera Blue Cross Individual Signature network.

    Forms

    Individual plan forms:

    Visit our forms page for all other provider documents.

    Medical policies

    Review our individual plan policies on our policy page.

    Individual plans have a specific code list and InterQual criteria when reviewing certain services.

    Care management

    Learn about our programs that help members navigate the healthcare system and manage their health.

    Contact information for individual plans

    Customer service

    Call customer service at 800-809-9361 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. Customer service can also provide web support and information on member eligibility and benefits.

    Claims and clinical appeals address

    Individual plan claims, appeals, and other paper correspondence must be sent to:

    Premera Blue Cross
    P.O. Box 21762
    Eagan, MN 55121

    Utilization management

    Call 844-966-0332 or fax 888-584-8081 to contact our utilization management team. Use this fax number to submit a prior authorization request.

    Electronic funds transfer for individual plans

    InstaMed delivers all electronic funds transfer (EFT) payments and electronic remittance advice (ERA) for individual plans. If you submit and receive EFT/ERA through a clearing house, the clearing house needs to sign up for InstaMed.

    Already have InstaMed?

    Great! You’ll automatically receive EFT payments for our individual plan claims.

    New to InstaMed?

    You have 2 simple ways to sign up: