Reminders and Updates - Provider News

Policy updates

Find recent medical policy and coding updates and payment policy updates.

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Reminders and updates

Enhancing Accessibility: New Method for Submitting Medical Records | 11/6/2023
You can now submit medical records for claims processing via fax
New COVID-19 Vaccines Available | 10/6/2023
Updated information on COVID-19 vaccines, billing, and codes
Shining a Light on At-Home Treatment Options for Skin Conditions | 10/5/2023
Consider at-home photo therapy as a potential treatment option before opting for biologics
New Edits for First-Pass Claims Editor | 10/5/2023
Upcoming new edits will enforce Payment Policy and Correct Coding guidelines
Provider Directory Notice: Check Your Status with BetterDoctor | 10/5/2023
Here’s what you need to know about BetterDoctor and verifying your information with Premera Blue Cross Blue Shield of Alaska
UPDATE: Optum Financial Moves to Virtual Credit Card (Vcard) Payment | 10/5/2023
Window for processing Vcards before a check is sent moving from 45 days to 30
Consultation Code Services Payment Policy Expanding to Include Alaska Providers | 9/7/2023
New policy takes effect December 11, 2023
Modifier 90 Reference/Outside Laboratory Policy Expansion to Include Facility Claims | 9/7/2023
Facility claims submitting lab services with Modifier 90 will be denied reimbursement
Notification of Recredentialing Completion | 9/7/2023
Letters being sent to providers to inform them their recredentialing process is complete
New Provider Customer Service Hours | 8/3/2023
Provider customer service hours are now 6 a.m. to 5 p.m
Survey Ends on August 8 | 8/3/2023
Help us improve the Premera provider experience
Be Alert for Scam Callers | 8/3/2023
Scam vendors may call for patient information
Premera Welcomes Matanuska-Susitna Education Association Union Employees | 7/6/2023
Employees of Matanuska-Susitna Borough School District will receive benefits through Premera Blue Cross Blue Shield of Alaska
Preventive Service Updates Rolled Out July 1 | 7/6/2023
Learn about changes to our preventive care benefits
Avoid Removal from the Provider Directory | 7/6/2023
Important information to help you keep your provider data current and visible
Reminder to Check Eligibility and Benefits | 7/6/2023
Services and pharmacy benefits may change for some employer groups who customize their plans
Reminder: Claims Editor Changes Starting on July 8 | 6/1/2023
The new claim editor will continue to enforce correct coding and billing practices and evaluate current claims against Premera’s historical claims for editing purposes
Health Sector Coordinating Council Releases “Cybersecurity for the Clinician” Video Training Series | 5/4/2023
This series explains the basics for how cyber-attacks can affect clinical operations and patient safety
How To Submit a Corrected Claim | 5/4/2023
The preferred process for submitting corrected claims is to use the 837 transaction for both professional and facility claims, and the claim frequency code 7
Help Keep Your Provider Data Current | 5/4/2023
Updating your information can ensure you’re meeting federal requirements for provider data
COVID-19 PHE Requirements ending May 11, 2023 | 5/4/2023
The federal government has rescinded many of the requirements put in place during the COVID-19 Public Health Emergency (PHE). The following changes will be effective May 11, 2023
Optum Financial Moves to Virtual Credit Card Payment | 4/6/2023
You can change your payment method through Optum Financial
New Quality and Coding Tools for Premera Providers | 4/6/2023
Visit our new web page for quality measures and coding tip sheets
End of the Public Health Emergency Brings Changes to Payment Policies | 4/6/2023
Premera will be updating payment policies to reflect the federal government ending the COVID-19 public health emergency
New Edits for Drug Waste on Professional and Facility Claims | 4/6/2023
Review the details in these policies to learn how to correctly code for drug wastage
Keep Your Provider Data Current | 3/2/2023
Information to help you ensure you’re meeting federal requirements for provider data
AIM Specialty Health Transitioned to Carelon | 3/2/2023
AIM Specialty Health changed its name to Carelon Medical Benefits Management on March 1, 2023
How To Submit Admission Notification | 3/2/2023
Information to help you ensure you’re meeting federal requirements for provider data
AIM Specialty Health Transitions to Carelon | 2/2/2023
AIM Specialty Health will have a new name, Carelon, on March 1, 2023
Preventive Services Updates for 2023 | 12/1/2022
Changes to our preventive care benefits are coming in January
Making Provider Directory Accuracy a Priority | 12/1/2022
Premera is working with BetterDoctor to ensure the accuracy of your information in our provider directory
Stay Up to Date on All Payment Policy Changes | 12/1/2022
Review the latest payment policy updates for changes that may affect your claims payment
Prevent Claim Edits and Denials with These Tips | 11/3/2022
If a procedure code doesn’t match the anatomic site of the modifier, the procedure code will be denied - learn more tips
Participate in the 2022 Provider Survey | 10/6/2022
Help Premera better serve our providers and members
Upcoming Changes to CPT Evaluation and Management Coding | 10/6/2022
The American Medical Association revised the E&M coding guidelines and code descriptions
Premera Pulse Ending | 10/6/2022
Features like finding in-network care, accessing medication lists, and reminders will be available in other programs
Reminder: Title Revision for Physical, Occupational, and Speech Therapy Services Payment Policy | 10/6/2022
In July 2022, the title of physical, occupational, and speech therapy services payment policy was updated and the policy code 97127 was removed
New Payment Policy: Place of Service Codes | 9/1/2022
Learn more about place of service (POS) codes that don’t reflect where a service was performed or received
Changes to Group Psychotherapy Policy | 9/1/2022
Policy exceptions being removed from policy
Botulinum Toxins will Require a Prior Authorization | 9/1/2022
Read more about the new medical policy
Provider Directory Notice: Check Your Status with BetterDoctor | 9/1/2022
Premera is working with BetterDoctor to ensure the accuracy of your information and meet provider directory requirements in the federal No Surprises Act
Premera Premier Provider Program Introduces Enhancements | 8/4/2022
Enhancements include robust data for inpatient and outpatient quality measurements, extended review periods, and more
DataWise: Premera’s Interoperability Program | 8/4/2022
See how interoperability data sharing can help close gaps and improve health outcomes
Provider Taxonomy Codes Needed on Claim Forms | 7/7/2022
Add your specialty taxonomy code to claims to assist in correct editing
Preventive Services Updates For 2022 | 6/2/2022
Learn about changes to our preventive care benefits
Overpayment Recovery Update | 4/1/2022
Effort for being made to reduce our carbon footprint by reducing mailing and streamline work for providers
New Payment Policy: COVID-19 Testing | 4/1/2022
Diagnostic testing, surveillance testing and over the counter tests reviewed
Audio-only Telehealth Modifiers | 4/1/2022
Audio-only services need to be identified by adding one of the new audio-only modifiers
Applied Behavior Analysis Services Through Telehealth Extended | 4/1/2022
The allowance for applied behavioral analysis (ABA) services provided via telehealth has been extended through June 30, 2022
Waiver of Medical Necessity Requirements | 4/1/2022
The waiver for authorization requirements for transfers to lower levels of care and medical necessity requirements for air/ground transportation ends April 16, 2022
Electronic Remittance Tips | 2/24/2022
Enroll with Premera and InstaMed to ensure you receive all electronic remittance
Add Your Bio/Photo to Our Provider Directory | 2/24/2022
Upload up to 20 images at a time
Total Joint Replacement Program Has Expanded to Alaska | 2/24/2022
Alaska members now have access to the Total Joint Replacement bundle
Availity Essentials Secure Provider Website Updates | 2/24/2022
Here are some helpful tips for using Availity
Over-the-Counter COVID-19 Testing and Government Tests | 2/3/2022
Health plans are required to cover member-purchased over-the-counter (OTC) COVID-19 tests
New Code for Post COVID-19 Conditions | 1/6/2022
This code is for conditions which are the consequence of COVID-19.
AIM Provider Portal Changes | 1/6/2022
AIM provider portal allows users to see the order ID on all authorization requests.
Enhanced Edits Based on Provider Specialty | 1/6/2022
Provider’s specialty and tax identification number will be used to determine application of edits.
No Surprises Act: Understanding Balance Billing Rules | 12/16/2021
Learn about the balance billing rules coming with the No Surprises Act in 2022.
Understanding the No Surprises Act Dispute Resolution Process | 12/16/2021
Learn about the new federal dispute resolution provisions starting January 1, 2022.
Pre-Certification Required for FEP Member Inpatient Stay | 12/16/2021
If the Federal Employee Program (FEP) member’s admission is not pre-certified for an inpatient stay, FEP may not provide benefits.
Preventive Services Update: Colorectal Cancer Screenings | 12/16/2021
Learn about an age range change to our preventive benefits for colorectal cancer screenings.
Telehealth Place of Service Code | 12/16/2021
New place of service code for telehealth provided in patient’s home.
Pre-certification will be Required for FEP Members Inpatient Stays | 12/2/2021
Pre-certification will be required for inpatient stays for all Blue Cross and Blue Shield Federal Employee Program (FEP) members
Pediatric COVID-19 Vaccine Codes and Eligibility | 11/18/2021
Vaccine codes are now available for children ages 2-11.
Codes and Eligibility for COVID-19 Booster Shots | 11/18/2021
Use the correct codes when submitting claims for COVID-19 vaccines and boosters.
Billing for Delivery and Postpartum Care Services | 11/4/2021
Only one submission of postpartum care will be allowed per pregnancy.
Understanding Provider Directory Requirements for the No Surprises Act | 11/4/2021
Learn about the new provider directory rules starting January 1, 2022.
Telehealth/Virtual Encounter Documentation and Billing Guidelines | 11/4/2021
Correctly code your telehealth encounter for reimbursement.
Federal No Surprises Act Explained | 10/21/2021
What you need to know about the new legislation taking effect January 1, 2022.
New Process in 2022 for Specialized Therapy Requests | 10/21/2021
Effective January 3, 2022, eviCore is updating its clinical collection process for specialized therapy requests.
Prior Authorization Required for Hysterectomy Surgeries in 2022 | 10/7/2021
Prior authorization and site of service will be required for hysterectomy for dates of service January 7, 2022 and beyond
Update to PrEP Preventive Services Coverage | 9/16/2021
Learn about an important change to our preventive care benefits for pre-exposure prophylaxis
New Payment Policy: Therapy Assistant Modifiers | 9/16/2021
Physical therapy and occupational therapy assistant modifiers now required
Prior Authorization Requirements Temporarily Waived for SNF Transfers | 9/16/2021
We’re temporarily waiving the prior authorization requirement for skilled nursing facilities
Inpatient Stays will Require Pre-certification for FEP Members | 9/16/2021
If a precertification isn’t done for FEP inpatient stays, payments will be reduced
Extending Length of Approval for Prior Authorizations | 9/16/2021
Premera has extended the length of approval for prior authorizations to 180-days
Help Premera Provide Timely and Efficient Care for Our Members | 9/2/2021
The network awareness survey ensures our providers and staff are aware of our available networks
Provider Workshop: Claims Editing | 9/2/2021
Join us for an overview of our claims editing process and the implementation of coding validation
Hospital and Hospital System Readmission Payment Policy Revisions | 9/2/2021
Find out more about significant content changes to this policy
Provider Directory Verification is Moving to Better Doctor | 8/19/2021
We’re streamlining the verification process to comply with federal regulations
Philips Respironics Recalled Ventilators, BiPAP and CPAP Machines | 8/19/2021
Learn more about the Philips Respironics recall
Third COVID Vaccine Dose Approved | 8/19/2021
A third dose is recommended for patients with moderate or severe primary immunodeficiency
Expanded Prior Authorizations for BlueCard® Members | 8/5/2021
Some BlueCard members need prior authorization for elective or non-emergency outpatient radiology or cardiac imaging services
New Tools to Estimate Patient Costs will be Introduced in 2022 | 8/5/2021
The real-time estimator tool no longer available
Transparency in Coverage Rule | 7/2/2021
What is this new rule and what will Premera do to comply.
New Prior Approval Form for FEP | 7/1/2021
New Federal Employee prior approval form now available for Applied Behavior Analysis review requests
Health Plans Now Required to Provide Access to Patient Clinical Records | 7/1/2021
New requirements give members timely access to their health data to better manage their own care
Updates to CMS Guidance on Telehealth Visits | 7/1/2021
Telehealth reimbursements change on September 1, 2021
Payment Policy Revisions | 6/3/2021
Recent revisions to payment policies affect claims payment
Real-Time Estimator Tool Remains Unavailable | 6/3/2021
Our real-time estimator tool remains down for maintenance until further notice
New Policy for Lab Billings | 6/3/2021
Billing guidelines for laboratory and pathology services
Preventive Services Updates for 2021 | 6/3/2021
Learn about changes to our preventive care benefits
New Provider Update Form | 6/3/2021
The provider update form makes it easier to submit your provider, facility, or location updates online
COVID Treatment Cost Shares ends June 30 | 6/3/2021
The COVID treatment cost share waiver will end on June 30, 2021
Handwritten Fax Forms No Longer Accepted Starting June 1 | 5/14/2021
Starting June 1, we’re only accepting electronic prior authorization fax forms
Personal Health Support Programs | 5/14/2021
Premera offers a personalized, one-on-one support program to help your patients manage their condition
Credentialing TIN Requirement Update | 5/6/2021
Send us your SS-4 letter instead of W-9
Refund Payment Format Updated | 5/6/2021
Premera is reducing its carbon footprint and streamlining work
Annual Risk Adjustment Data Validation Audits | 5/6/2021
Offices may receive a request for medical records from Cognisight or Premera
Don’t Forget the Signed Member Authorization | 5/6/2021
A signed member authorization is needed for appeals submitted on the member’s behalf
2021 Provider Workshops | 4/9/2021
Join Premera for online training and educational opportunities
Contract Exclusions Payment Policy | 4/9/2021
Clarification for the Contract Exclusions payment policy
OneHealthPort Multi-Factor Authentication Begins on May 10 | 4/9/2021
Multi-Factor Authentication will be added to OneHealthPort's Single Sign-On service
Patients Can Get More Control of Their Health Data | 4/9/2021
New rules require health plans to provide patient clinical records access within 24 hours
New FEP Fax Cover Sheet | 3/18/2021
This new form can save you time!
Alaska Fee Schedule | 3/4/2021
An update to the fee schedule for professional services is coming May 15, 2021.
Upcoming Facility and Professional Claim Edits | 3/4/2021
Edits will be enforcing correct coding of diagnosis codes and procedure codes.
Shared Administration Contact List | 2/18/2021
The Shared Administration Contact List can help you find what you need.
Provider Workshop: COVID-19 | 2/4/2021
Join Premera for a provider workshop to discuss the COVID-19 vaccine, billing and coding, virtual care, and more.
New Codes for Coronavirus and Vaccines | 2/4/2021
Providers must use new ICD-10 codes.
COVID-19 Vaccine Updates | 1/7/2021
What you need to know to administer the vaccine.
Has Your Office Information Changed Recently? | 1/7/2021
Make sure your information is also current in our provider directory.
New Steps for Admission Notification | 1/7/2021
You now have more time to submit medical records for admissions.
Updated Virtual Care Benefits | 1/7/2021
IOP and PHP virtual care are now standard benefits.
COVID-19 Vaccine Updates | 12/17/2020
What you need to know to administer the vaccine.
2021 ID Card Guide Available | 12/17/2020
View sample ID cards and learn about new plans, networks, and copays.
Provider Workshop: Premera 101 | 12/17/2020
Join us for an introduction to our secure online tools and quick tips for success.
Modifier 90 Edit Expansion to Facility Claims Rescinded | 12/3/2020
Coding edits for modifier 90 won’t be expanded to facility claims.
Eligibility and Benefits Workshop Overview | 11/19/2020
Highlights from the November 11 provider workshop.
Reimbursements for Some September Telehealth Claims | 11/19/2020
We’re reprocessing telehealth claims providers submitted to reimburse at the in person allowed amount.
MOBE Program Discontinuing | 11/5/2020
Premera will discontinuing the MOBE program effective December 31, 2020.
Virtual Care Documentation Best Practice | 11/5/2020
Are you documenting all the elements of a telehealth visit?
Take the Provider Directory Survey for a Chance to Win a Gift Card | 11/5/2020
Help us improve our provider directory.
Payment Policy: Personal Protective Equipment | 11/5/2020
Personal protective equipment (PPE) will no longer be separately reimbursable.
Repayment Begins for the Advance Payment Program on January 1 | 11/5/2020
Look for an email noting your options for repayment.
Modifier 90 Edit Extending to Facility Claims | 10/15/2020
Correct coding edits for modifier 90 will apply to facility claims.
Use Overpayment Forms When Returning Checks to Premera | 10/15/2020
Forms save a significant amount of administrative time for all.
Survey Results: Medical and Behavioral Health Collaboration | 10/15/2020
Learn more about the results and how they can help your practice.
Premera Extends the POS Payment of Telehealth Visits | 10/15/2020
Providers need to continue use the telehealth place of service (POS) 02 with the procedure code appended with either modifier 95 or GT.
Relocating? Learn About Continuing Out-of-State Telehealth Services | 10/1/2020
If your practice moves out of state, it’s possible we can continue to work together.
Complete the Provider Network Survey | 10/1/2020
Tell us how to improve our network information.
Billing Telehealth Services | 10/1/2020
Providers need to bill POS 02 for all telehealth services delivered after September 1.
Updates to Claims Editor/What If Tool | 9/17/2020
Check your claim in the What If Tool to identify potential edits.
Participate in Provider Network Awareness Survey | 9/17/2020
We’re working to ensure our ongoing efforts lead to timely and efficient care for our members.
Overpayment Recoupment Ending | 9/3/2020
Premera will begin recouping overpayments in September.
Upcoming New Professional and Facility Claim Edits | 9/3/2020
Additional correct coding claim edits will be applied to professional and facility claims.
Customer Service Hours Changing: Use Online Tools to Save Time | 9/3/2020
Provider customer service hours are changing to 8 a.m. to 5 p.m.
Tips for Billing a Telehealth Originating Site Fee | 8/20/2020
Learn what the originating site means for telehealth services.
Coding and Billing of a Telehealth Encounter | 8/20/2020
Telehealth services are returning to correct coding and billing of a telehealth encounter.
Coverage for Return-to-Work Antigen and Antibody Testing | 8/6/2020
Premera will not include molecular/antigen or antibody testing for return-to-work strategies.
New Payment Policy: Personal Protective Equipment | 7/16/2020
Personal Protective Equipment (PPE) will no longer be reimbursed.
Reviewing HCPCS C Codes for Medical Necessity | 7/16/2020
Premera will be reviewing HCPCS codes in the “C” series for medical necessity.
Save Time by Using the Correct Forms | 7/2/2020
Find out which 3 forms are the most commonly misused.
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Reminders and Updates - Provider News

Policy updates

News

Reminders and updates

Enhancing Accessibility: New Method for Submitting Medical Records | 11/6/2023

New COVID-19 Vaccines Available | 10/6/2023

Shining a Light on At-Home Treatment Options for Skin Conditions | 10/5/2023

New Edits for First-Pass Claims Editor | 10/5/2023

Provider Directory Notice: Check Your Status with BetterDoctor | 10/5/2023

UPDATE: Optum Financial Moves to Virtual Credit Card (Vcard) Payment | 10/5/2023

Consultation Code Services Payment Policy Expanding to Include Alaska Providers | 9/7/2023

Modifier 90 Reference/Outside Laboratory Policy Expansion to Include Facility Claims | 9/7/2023

Notification of Recredentialing Completion | 9/7/2023

New Provider Customer Service Hours | 8/3/2023

Survey Ends on August 8 | 8/3/2023

Be Alert for Scam Callers | 8/3/2023

Premera Welcomes Matanuska-Susitna Education Association Union Employees | 7/6/2023

Preventive Service Updates Rolled Out July 1 | 7/6/2023

Avoid Removal from the Provider Directory | 7/6/2023

Reminder to Check Eligibility and Benefits | 7/6/2023

Reminder: Claims Editor Changes Starting on July 8 | 6/1/2023

Health Sector Coordinating Council Releases “Cybersecurity for the Clinician” Video Training Series | 5/4/2023

How To Submit a Corrected Claim | 5/4/2023

Help Keep Your Provider Data Current | 5/4/2023

COVID-19 PHE Requirements ending May 11, 2023 | 5/4/2023

Optum Financial Moves to Virtual Credit Card Payment | 4/6/2023

New Quality and Coding Tools for Premera Providers | 4/6/2023

End of the Public Health Emergency Brings Changes to Payment Policies | 4/6/2023

New Edits for Drug Waste on Professional and Facility Claims | 4/6/2023

Keep Your Provider Data Current | 3/2/2023

AIM Specialty Health Transitioned to Carelon | 3/2/2023

How To Submit Admission Notification | 3/2/2023

AIM Specialty Health Transitions to Carelon | 2/2/2023

Preventive Services Updates for 2023 | 12/1/2022

Making Provider Directory Accuracy a Priority | 12/1/2022

Stay Up to Date on All Payment Policy Changes | 12/1/2022

Prevent Claim Edits and Denials with These Tips | 11/3/2022

Participate in the 2022 Provider Survey | 10/6/2022

Upcoming Changes to CPT Evaluation and Management Coding | 10/6/2022

Premera Pulse Ending | 10/6/2022

Reminder: Title Revision for Physical, Occupational, and Speech Therapy Services Payment Policy | 10/6/2022

New Payment Policy: Place of Service Codes | 9/1/2022

Changes to Group Psychotherapy Policy | 9/1/2022

Botulinum Toxins will Require a Prior Authorization | 9/1/2022

Provider Directory Notice: Check Your Status with BetterDoctor | 9/1/2022

Premera Premier Provider Program Introduces Enhancements | 8/4/2022

DataWise: Premera’s Interoperability Program | 8/4/2022

Provider Taxonomy Codes Needed on Claim Forms | 7/7/2022

Preventive Services Updates For 2022 | 6/2/2022

Overpayment Recovery Update | 4/1/2022

New Payment Policy: COVID-19 Testing | 4/1/2022

Audio-only Telehealth Modifiers | 4/1/2022

Applied Behavior Analysis Services Through Telehealth Extended | 4/1/2022

Waiver of Medical Necessity Requirements | 4/1/2022

Electronic Remittance Tips | 2/24/2022

Add Your Bio/Photo to Our Provider Directory | 2/24/2022

Total Joint Replacement Program Has Expanded to Alaska | 2/24/2022

Availity Essentials Secure Provider Website Updates | 2/24/2022

Over-the-Counter COVID-19 Testing and Government Tests | 2/3/2022

New Code for Post COVID-19 Conditions | 1/6/2022

AIM Provider Portal Changes | 1/6/2022

Enhanced Edits Based on Provider Specialty | 1/6/2022

No Surprises Act: Understanding Balance Billing Rules | 12/16/2021

Understanding the No Surprises Act Dispute Resolution Process | 12/16/2021

Pre-Certification Required for FEP Member Inpatient Stay | 12/16/2021

Preventive Services Update: Colorectal Cancer Screenings | 12/16/2021

Telehealth Place of Service Code | 12/16/2021

Pre-certification will be Required for FEP Members Inpatient Stays | 12/2/2021

Pediatric COVID-19 Vaccine Codes and Eligibility | 11/18/2021

Codes and Eligibility for COVID-19 Booster Shots | 11/18/2021

Billing for Delivery and Postpartum Care Services | 11/4/2021

Understanding Provider Directory Requirements for the No Surprises Act | 11/4/2021

Telehealth/Virtual Encounter Documentation and Billing Guidelines | 11/4/2021

Federal No Surprises Act Explained | 10/21/2021

New Process in 2022 for Specialized Therapy Requests | 10/21/2021

Prior Authorization Required for Hysterectomy Surgeries in 2022 | 10/7/2021

Update to PrEP Preventive Services Coverage | 9/16/2021

New Payment Policy: Therapy Assistant Modifiers | 9/16/2021

Prior Authorization Requirements Temporarily Waived for SNF Transfers | 9/16/2021

Inpatient Stays will Require Pre-certification for FEP Members | 9/16/2021