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, and the local Blue plan in your state is contracted with Availity, you can check eligibility and benefits, submit prior authorizations and
check status, and submit a claim and get status for Premera members. Just select Other Blue Plans or Your Local Blue Plan and enter the member ID (include the prefix).
If you’re a dental provider, select Premera Dental from the Availity payer list (available in all states). Premera uses the United Concordia Advantage Plus Network for out-of-state dental members.
Federal No Surprises Act
Learn about reducing unexpected medical bills.
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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. Prior
authorizations can't be submitted by phone.
Choose Premera as the Payer in Availity
Providers outside of Washington or Alaska can use their current Availity state to submit prior authorizations. Premera Blue Cross Blue Shield of Alaska is listed as a payer for Authorizations & Referrals
in all states.
How to submit prior authorization
1. Find out if a code needs review
Sign in to Availity and use our code check tool to see if we require a prior authorization or a pre-service review. Our code check tool is located in every state under Availity Authorizations
and Referrals > Additional Authorizations and Referrals.
2. Submit for prior authorization and pre-service review:
The fastest way to receive a response to your request is to sign in to Availity. Use your current Availity state to submit prior authorizations. Premera Blue Cross
Blue Shield of Alaska is listed as a payer for Authorizations & Referrals in all states.
You can also 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 complete your request.
Lastly, you can fax in a completed request form.
Our medical policies are useful for checking coverage criteria.
3. Check review status
Sign in to Availity and check the status of your request online through the Auth/Referral Dashboard or Auth/Referral Inquiry. We typically respond within 1-2 business days, but it
can take up to 5 days. 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 Carelon Medical Benefits Management 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.
Pharmacy
Use our Rx search tool to see if a drug requires prior authorization.
Inpatient admissions policies
View inpatient admission notification policies to see which services require admission notification and what to do for urgent care situations. If notification is required, complete
an admission notification request form and fax it to 888-742-1487.
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 by calling 877-342-5258,
option 3. This number is for admission notification only. You can also fax us an admission notification request form.
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, Carelon Medical Benefits Management (formerly 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.