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Company Closure Notice The Premera offices will be closed on Friday, July 3. During this time, all of our online tools will be available. We expect higher-than-normal call volumes on Monday, July 6, so we encourage you to continue using our online tools to avoid long wait times.
An important notice about pathology/laboratory services
CellNetix is a provider of pathology services that is no longer in Premera’s network. We have asked the healthcare providers in our network to send our members’ pathology work to an alternative pathology provider. Having pathology tests performed by CellNetix could result in higher out-of-pocket costs. If members visit one of the following healthcare providers, they should be aware their pathology work may be sent to CellNetix unless they request otherwise: Swedish Hospitals and Swedish Medical Group, The Polyclinic; Northwest Hospital and Medical Center; Providence Regional Medical Center Everett and Providence Medical Groups; Minor & James Medical; Highline Medical Center; and The Everett Clinic.
Register to manage your group's plan. You can update membership, run reports, view billing, and more.
Virtual care gives members immediate and convenient access to care whenever and wherever they need it (except in Idaho).
Members who are covered (as plans enroll or renew beginning January 1, 2015) receive care virtually from their own doctor or from a doctor at our national provider service, Teladoc®.Covered members can get care via phone call, online video, or other online media at least as easily as they walk into an office and get care face to face.To find out more about Virtual Care, contact your Premera sales representative.
Our new virtual care solution is getting a lot of media coverage. Check out an article in the Seattle Times, Herald Business Journal, or State of Reform
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, 2015. 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.
Rx Search - Use this tool to get information about your employees' prescription drugs, including how a drug is covered by a Premera plan.
PremeraNews.com - 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.
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For Plan Administrators
Ready-to-use resources to communicate healthcare benefits and wellness information to your employees.