Electronic Claims Overview

  • 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:

    • Less time spent on claims preparation
    • Cost savings through prevention of loss and potential delay
    • Detailed claim acceptance and rejection reporting
    • Faster claims processing and response times
    • Eliminates calls for patient eligibilty, benefits, or claim status
    • Professional help with Electronic Data Interchange (EDI) matters
  • Submit Claims, Inquiry/Request Transactions Electronically

    1. Contact your software vendor directly to discuss installing electronic media claims and inquiry/request transaction capabilities in your office. Contact us for a list of approved software vendors.
    2. After you select your software, contact us for a list of approved software vendors.for electronic submitter enrollment information.
    3. Next, send your test files. If you use an approved clearinghouse, no testing is required.
    4. After approval for production, you can send claim files, monitor your reports, and send inquiry/request transactions.
    5. If you already use a clearinghouse to send your claims electronically, contact them to set up sending inquiry/request transactions. It's that simple!

    Send Claims Via Secure Transport

    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:

    • Ability to upload claims and inquiry/request transaction files
    • Convenience via connectiva.com, available 24/7
    • File upload success confirmation acknowledgement or error notification
    • Ability to send and receive HIPAA standard transactions
    • Online access to download:
      • All Premera electronic claims reports and inquiry/request response transactions
      • Electronic Remittance Advice (ANSI, ASC 835) for Premera products

    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 Blue Cross (Washington)
    • Premera Blue Cross Blue Shield of Alaska
    • LifeWise Health Plan of Washington
    • LifeWise Health Plan of Oregon
    • BlueCard (out-of-area) Program
    • Federal Employee Program (FEP) where applicable*
    • NASCO (National Accounts)

    *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. Vist premera.com/fep/provider "Where Should I Submit My Claims?" to learn more about submitting claims by county.

    Claim Types

    The following claim types may be billed electronically:


    • Medical
    • Vision
    • Dental
    • Durable medical equipment and supplies
    • Chiropractic
    • Other alternative healthcare services


    • Institutional and facility claims
    • FEP institutional claims for all counties within the states of Washington and Alaska


    • Premera accepts dental claims from providers nationwide (exception: Washington FEP)
    • FEP Dental Claims 
      • Premera accepts Federal Employee Program (FEP) dental claims for Alaska only
      • Premera does not accept Washington FEP dental claims; these must be submitted to Regence BlueShield

    Electronic Transaction Formats

    Premera uses the HIPAA-mandated ANSI Healthcare, ASC X12N Version 5010 for the following electronic transactions:

    • American National Standards Institute (ANSI)
    • Accredited Standards Committee X12N (Insurance ASCX12N)
    • Institutional Claims
    Transaction Number Transaction Type Method
    835 Electronic Remittance Advice Batch
    837 Claims, Dental, Professional, Institutional/Facility Batch
    270/271 Healthcare Eligibility
    Batch or Real Time
    276/277 Healthcare Claim Status
    Batch or Real Time
    278 Healthcare Services Review
    Request for review and Response
    999 Healthcare Acknowledgement  


    More information 


    Electronic Claims Transaction Reporting

    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:

    • Specific detail on claims that have failed our HIPAA validation
    • List of claims rejected upfront that won't reach our adjudication system
    • Detailed information on all claims accepted for adjudication and any claims rejected for member eligibility

    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:

    • Diagnosis code
    • Date of service/date span
    • Total charges or units billed
    • Member/patient or provider
    • Originally submitted procedure code
    • Modifier on a previously processed claim
    • Charges for services not previously billed (late charges)

    Instructions for Submitting Corrected/Replacement Claims

    Providers should submit a corrected or replacement claim electronically using the HIPAA 837 standard claims transaction, and include the following information:

    • Frequency Code of ‘7’ in Loop 2300, CLM05-3 segment to indicate a corrected/replacement of a prior claim
    • All services from the original claim, including the corrected services
    • The initial Premera claim reference number or claim number (in Loop 2300, REF01 must contain “F8” and REF02 must contain the claim number)
    • 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

    More Information and Resources

    Please verify filing guidelines in your provider contract.

    Mountlake Terrace, WA

    (Seattle Office)
    Phone: 800-435-2715
    Fax: 425-918-4234

    Spokane, WA

    Phone: 800-435-2715
    Fax: 509-532-6352


    Phone: 800-435-2715
    Fax: 541-318-2337

    Mailing Address:

    Premera Blue Cross
    P.O. Box 327
    EDI MS-481
    Mail Stop 481, EDI
    Seattle, WA 98111-0327

    Delivery Address:

    Premera Blue Cross
    7001 220th Street SW

    EDI MS-481
    Mountlake Terrace, WA 98043-2124