Sending electronic data interchange (EDI) transactions can help claims process faster and improve your cash flow.
Premera supports the exchange of all transactions mandated by the Health Insurance Portability and Accountability Act (HIPAA). Premera can exchange transactions with you directly or through a billing service or clearinghouse.
Claim payer IDs are used to make sure your electronic transaction is routed to the right health plan. If you're using a clearinghouse, be sure to verify all payer IDs as they might request that you use a different payer ID than those listed here.
*These payer IDs work for all Premera plans, including Premera HMO, Medicare Advantage, FEP, BlueCard, and NASCO.
A clearinghouse acts as a go-between for the provider and the payer (health plan). Using a clearinghouse means you can reach multiple payers through a single vendor.
Direct submitter to Premera EDI (no clearinghouse)Before you enroll, you'll need to check with your system
vendor to confirm that your system can send in the HIPAA (x12)-required format. This option is typically used by
large facilities, large provider groups and billing services. Please email us for more information.
Using a clearinghouseYou can submit electronic claims to Premera EDI using the
clearinghouse of your choice or the choice of your software vendor if the
clearinghouse is enrolled with us. Please check with your clearinghouse
or software vendor on how to submit an electronic claim to Premera EDI. Small offices or individual providers
who don't want to accrue fees from a clearinghouse are encouraged to use
Office Ally free of charge when submitting to Premera EDI. Please email
us for Office Ally pre-enrollment
information or visit www.OfficeAlly.com.
How will I know if my electronic claim was accepted or rejected?
We create an accept/reject report that we share with our direct submitters and clearinghouses. Check with your clearinghouse about receiving reports.
NOTE: Make sure your National Provider Identifier (NPI) is
submitted on your electronic claim. If you are a dual-licensed provider,
please ensure the appropriate taxonomy code is submitted on your claim. Taxonomy codes will need to be registered on the NPPES website. If you have questions or need to
update your provider record to include your taxonomy code(s), please contact
NPPES at 800-465-3203.
Premera accepts claim transactions for the following plans:
We accept electronic claims for out-of-state Blue plans through the BlueCard Program. You can submit your BlueCard claims with your regular transmission files to us, using the same payer ID, and we'll coordinate with the member's home plan. Be sure to include the three-character plan prefix when submitting BlueCard claims. View BlueCard plan prefix list (login required). For more information, call our BlueCard team at 888-261-9562.
Electronic Remittance EnrollmentPremera electronic remittance is available for all local providers regardless of contract status. To enroll with Premera EDI to receive electronic remittance, please contact your software vendor or
clearinghouse for enrollment information. If you're a direct submitter to Premera EDI or use Office Ally as your clearinghouse, you can request the electronic remittance enrollment form by sending an email to EDI@Premera.com.
We currently partner with many EDI clearinghouses and vendors, including:
Athena HealthAvailityChange Health CareClaim MDElectronic Network SystemsEligible, Inc.ExperianGE HealthGroup Health Coop (GHC)Health Mgmt Systems (GainWell)InstaMedLogix HealthMedical Financial
SpecialistsOffice AllyPhiCure, Inc.Relay Health/McKessonSSI GroupTrizetto - CognizantTrubridge (CPSI)XiFin
We can add a new clearinghouse upon review and approval.
Premera Individual Plans Use InstaMedPremera Individual Plans are handled through the clearinghouse InstaMed. To enroll to receive the Premera Individual Plan in addition to Premera EDI electronic remittance reports,
enroll with InstaMed using the following options:
Complete the online form and fax it to 877-755-3392.
Call InstaMed at 866-945-7990.
Premera also offers the following HIPAA transactions.
Please contact us for details on exchanging specific transactions other than claims.
You can submit a corrected, replacement, or voided claim electronically using the HIPAA 837 standard claims transaction. Please include the following information:
When sending us a secondary claim, please include the following required information:
If you have questions about billing these from your system, please contact your system vendor or clearinghouse.
Medicare note: When Premera is secondary to Medicare, there's no need to submit claims to Premera if your Medicare explanation of payment indicates the claim was forwarded (or crossed over) to the secondary payer. Submitting the claim to us will cause a duplicate.
BlueCard Program – Learn about electronic claims for out-of-state Blue plans.
Federal Employee Plan (FEP) – Use this website for FEP members in Washington and Alaska.
Electronic Funds Transfer (EFT) – Sign up for convenient, faster payments.
National Uniform Claim Committee (NUCC) – Learn about mapping from the 1500 claim form to 837.
National Uniform Billing Committee (NUBC) – Get additional institutional claim information.
OneHealthPort – View best practices for electronic transactions.
Email: EDI@premera.comFax: 425-918-4234 (for EDI enrollment forms only; no claims or PPI information)
To submit paper
claims, correspondence, or medical records, please see the
back of the subscriber’s ID card for the correct mailing address.