Save Time by Using the Correct Forms

  • July 2, 2020

    One of the best ways we can serve our members is to make sure providers are using the correct Premera forms. Using the right form means important issues like appeals or supporting documentation for claims can get quickly routed to the right department.

    The top 3 most commonly misused forms include:

    • Corrected claim cover sheet:  Use the corrected claim cover sheet to correct billing information on a previously processed claim. This includes correcting charges, changing codes or modifiers, or adding an explanation of payment (EOP). For more details, see the section called ‘Corrected, replacement, voided, and secondary claims’ in Electronic Transactions.

    • Supporting document cover sheet: Use a supporting document cover sheet when you need to send us supporting documentation for processing a claim, such as:
      • A primary EOP
      • Supporting medical records
      • Or other requested documentation

    • Appeal form: Appeal forms are for resolving billing issues that directly impact payment or a write-off amount. Don’t submit an appeal form when:
      • Attaching medical records to support a claim
      • Attaching a primary explanation of payment (EOP)
      • Or submitting a corrected claim
      • Please don't submit an appeal form for the following:
        • Billing errors
        • Duplicate or eligibility denials
        • Corrected claims
        • Claims denied for needing medical records, incident questionnaires, or other additional processing info
        • Other coverage denials like COB, worker’s comp or subrogation

    We recently updated our provider forms page to help you find the right form by plan. Share Share this information with your office staff. If you have any questions or feedback about forms, send us an email.

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