Premera accepts electronic claims and inquiry/request transactions either by direct submission or from selected clearinghouses.
Sending electronic claims and inquiry/request transactions offer several advantages:
Sending electronic claims and inquiry/request transactions directly to Premera (if you don't use a clearinghouse) is accomplished via Secure Transport at connectiva.com. Secure Transport allows the transfer of files through a secure internet connection. It uses the standard security protocol of HTTPS and integrates SSL and Digital Certificate (X.509). Secure Transport is a proven solution that allows for the reliable delivery of both large and small files.
Your access to connectiva.com is through onehealthport.com. (You'll need to register for a user ID if you don't have one already.)
Premera Secure Transport services include:
If you have questions about Secure Transport, call our EDI Team at 800-435-2715.
Premera accepts professional, dental, and institutional/facility claims and inquiry/request transactions for the following:
*Premera accepts professional FEP medical claims from all physicians and healthcare providers in Eastern Washington counties except Walla Walla, Yakima, and Asotin. Please bill claims for care received in these counties to Regence BlueShield. Premera accepts institutional FEP claims for all counties within the state of Washington. Visit premera.com/fep/provider "Where Should I Submit My Claims?" to learn more about submitting claims by county.
The following claim types may be billed electronically:
Premera uses the HIPAA-mandated ANSI Healthcare, ASC X12N Version 5010 for the following electronic transactions:
The Electronic Data Interchange (EDI) process will return a 999 (Acknowledgement Transaction) and Electronic Claims Transaction Report to the submitting entity. For more information about 999s see HIPAA/EDI FAQ.
Electronic Reporting provides the following:
Note: Reports are posted electronically at connectiva.com.
A corrected/replacement claim is any claim that has changes or corrections to one of the following:
Providers should submit a corrected or replacement claim electronically using the HIPAA 837 standard claims transaction, and include the following information:
A free-form note with an explanation for the Corrected/Replacement Claim, in Loop 2300 ‘Claim Note’, as:
For Professional and Dental Claims, segment NTE01 must contain ‘ADD’ and segment NTE02 must contain the note, Example: NTE*ADD*CORRECTED PROCEDURE CODE
For Institutional Claims, segment NTE01 must contain ‘UPI’ and segment NTE02 must contain the note, Example: NTE*UPI*CORRECTED LAB CHARGES
Please verify filing guidelines in your provider contract.
(Seattle Office)Phone: 800-435-2715Fax: 425-918-4234
Phone: 800-435-2715Fax: 509-532-6352EDI@premera.com
Phone: 800-435-2715Fax: 541-318-2337EDI@premera.com
Premera Blue CrossP.O. Box 327EDI MS-481Mail Stop 481, EDISeattle, WA 98111-0327
Premera Blue Cross7001 220th Street SW
EDI MS-481Mountlake Terrace, WA 98043-2124
How does it affect you and how can you prepare for it?