Providers Outside of Washington and Alaska

  • Eligibility, benefits, and claim status

    Sign in to your local Blue plan's website. They pay the claim on our behalf and have the most current status.

    If you’re signed up with Availity, you can check eligibility and benefits for Premera members as well as submit a claim and get claims status. Just select Other Blue Plans or Your Local Blue Plan and enter the member ID.

    Prior authorization

    A service may require prior authorization. If you don't get a prior authorization, it could result in a payment penalty to the member. When a service requires pre-service review, there isn't a penalty, but we'll hold your claim and ask for medical records.

    Note: Prior authorizations can't be submitted by phone.

    How to submit prior authorization

    1. Find out if a code needs review

    Use our code check tool to see if we require a prior authorization or a pre-service review.

    2. Submit a review

    For prior authorization and pre-service review: Sign in to your service area's Blue plan website to find tools for out-of-area members. They'll route you to our prior authorization tool where you can submit a request and attach your records all at once.

    You can also fax in a completed request form. Our medical policies are useful for checking coverage criteria.

    3. Check review status

    After we receive all required materials, we typically respond within 5 business days. It may take up to 15 days if additional information is needed. Once we make a decision on your review request, we'll fax it to you. If your review request is denied, we'll mail a detailed letter to you and the member.

    Advanced imaging and other services

    For the best online experience with AIM and eviCore, start by signing in to your service area's Blue plan website to find tools for out-of-area members. You’ll be routed to their website where you can submit authorizations for Premera members.

    Advanced imaging and radiation oncology

    AIM logo

    Visit AIM Specialty Health or call 866-666-0776.

    Outpatient rehabilitation

    EviCore logo

    Visit eviCore healthcare. View Premera's list of codes that need review.

    Pharmacy

    Use our Rx search tool to see if a drug requires prior authorization.

    Inpatient admissions policies

    When you admit one of our members at a hospital, we require you to let us know by calling 877-342-5258, option 3. This number is only for admission notification. You can also fax us an admission notification request form. View inpatient admission notification policies to see which services require admission notification and what to do for urgent care situations.

    Emergencies and extenuating circumstances policy

    If an emergency prevents you from getting prior authorization before treating a patient or notifying us of admission within 24 hours, you must notify us within 48 hours following onset of treatment, or as soon as reasonably possible.

    In these situations, contact us before submitting a claim. Follow the recommended practices detailed in the extenuating circumstances policy so the claim isn't automatically denied.

    On behalf of Premera Blue Cross, AIM Specialty Health (AIM) is an independent company that manages imaging services for Premera.

    On behalf of Premera Blue Cross, eviCore healthcare (formerly known as CareCore National) is an independent company managing outpatient rehabilitation services for Premera providers.