April 20, 2017
As a provider, you may sometimes send appeals to Premera on behalf of a patient. Providers may appeal a denial letter about prior authorization or claims. Premera has different fax numbers and mailing addresses for clinical appeals and general appeals. Please confirm that your fax machine has both numbers listed and that your team has the right numbers. Sending your appeal to the wrong fax number can delay your claim.
See the correct fax numbers for each type of appeal and information on telling the difference between clinical and general appeals. The denial letter will include the reasons for the denial, along with a correct fax number for the appeal.
Clinical Appeals
Clinical appeals involve claims denied due to issues with the clinical care provided:
- Does not meet medical necessity
- Involves services that are experimental/investigational
- Involves a denial based on a need for prior authorization
Fax clinical appeals to 425-918-4133.
General Appeals
General appeals involve other types of claim denials. Fax general appeals to 425-918-5592.
If you can't fax your appeal, mail your appeals to:
Clinical appeals
P.O. Box 91102
MS 438
Seattle, WA 98111
General appeals
P.O. Box 91102
MS 123
Seattle, WA 98111