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Premera is introducing Prior Authorization as part of our efforts to help our members receive high quality cost-effective care consistent with clinical best practices. Prior Authorization requires members to make sure their provider requests an authorization in advance for certain services.
Effective September 1, Prior Authorization will apply to fully-insured large groups (51+) as they renew and enroll, both grandfathered and non-grandfathered. It will also apply to Self-funded Groups and National Accounts as they renew and enroll, and Self-funded Groups choose how the member penalty is applied if Prior Authorization is not obtained.
Prior Authorization will apply to Small Groups (1-50 employees) and Associations beginning January 1, 2014.
For more information about Prior Authorization, read the Producer Bulletin June Edition.
To ensure the safety of our members, Premera is implementing a Controlled Substance Utilization service. We will review prescription drug use by our members to make sure it meets standards of medical need, safety and best medical practices.
When our review identifies an instance where the use of addictive drugs may exceed safe levels, we contact the member.
Our Case Management team will work with the member using engagement and coaching techniques to uncover and address barriers to optimal health as well as coordinate services among healthcare providers.
Please contact your Premera Sales Representative if you have any questions.
Choosing Wisely® is a promotional campaign designed by the ABIM Foundation to increase physician/patient dialogue, employee health care literacy, and reduce waste in the healthcare system. It aims to promote conversations between physicians and patients by helping patients choose care that is:
General campaign messages include “Five Things Physicians and Patients Should Question” which is derived from twenty leading medical specialty societies. The campaign also promotes when specific tests and procedures such as imaging tests, EKG, and Pap tests may be appropriate, as well as the methodology used.
Check out Choosing Wisely: When to say ‘Whoa!’ to doctors or visit the Choosing Wisely website for more information.
Premera works closely with new employers to help you retain grandfathered status when joining our plan. The options, and levels of flexibility, depend on your group size.
For groups of 100 and more, we can review customization options for your plan to meet grandfathering criteria. Groups of 51-99 can purchase one of our existing products that already meets grandfathered status.
For groups of 50 or fewer, we recommend you contact your producer for assistance with understanding how to maintain your grandfathered status. If you’re interested in switching carriers to Premera, please contact your producer.
You may be familiar with ICD-9. This is the coding system used in healthcare to classify diseases and other health problems. It is also meant to promote international comparability in the collection, processing, classification, and presentation of mortality and health statistics. Premera uses these codes to standardize communication and payments to providers.
Many countries adopted ICD-10 in the 1990s. The United States will begin use of ICD-10 on October 1, 2013. The main difference in the two systems is the level of specificity. While ICD-9 contains 14,000 diagnosis codes, ICD-10 will have 69,000.
Premera has been preparing for ICD-10 for some time. We are working together with our contracted providers to ensure a smooth transition to the new system.
Small Groups (1-50 Employees)
Large Groups (51+ Employees)
Use this tool to get information about your employees' prescription drugs, including how a drug is covered by a Premera plan.
Check here for updates from Premera
Employee Communications Resources
A wealth of resources to help you communicate healthcare benefits, programs, and other wellness information
Health Savings Account Calculator for Employers
Use this tool to compare potential costs for a high deductible health plan paired with a health savings account