Premera uses ProviderSource ™ to manage data for credentialing, recredentialing, and privileging. ProviderSource is free and requires:
- An attestation date not older than 150 days.
- Up-to-date attachments, including the federal Drug Enforcement Administration (DEA) certificate and malpractice insurance fact sheet.
View our practitioner credentialing checklist or the Join Our Network page for more information.
Behavioral health specialty addendum - Provide us with your behavioral health primary areas of clinical expertise.
Dental provider credentialing application – Request to join our dental provider network.
IRS SS-4 confirmation letter - Include a copy of this letter to show your Employer Identification Number or EIN.
Provider updates and facility credentialing
Provider update - Email this form to Premera with new information or changes to your current practice or payment structure. The federal No Surprises Act requires health
plans to verify all provider directory data every 90 day. It also requires all
providers and facilities submit this information to in-network plans.
Unverified providers may be removed from our directory.
Organization/facility credentialing/recredentialing application - To join our provider network as a facility, complete this application
and a W-9 form. Email us your completed documents. The credentialing process typically takes 30 days. Acceptance is based on your application
information and network requirements. If your submitted application is accepted, you'll receive a contract to review and sign. Once you return your signed contract, you’ll receive a counter-signed contract and the effective date of your participation.