Premera uses Availity as the one-stop shop secure website for all Premera HMO provider needs. Availity is a single-source platform for the HMO health plan that providers can use to check member eligibility and benefits, monitor claim status
and submission, and submit referrals and prior authorizations. View Availity Quick Guide for online provider tools.
Availity is a free service. Sign in to
Availity or register and get training. View our Availity
provider FAQ for more details.
Availity offers the quickest way to obtain secure, personalized, easy-to-use information. Providers can:
- Verify member eligibility and benefits (including plan effective dates)
- Verify deductibles copay and coinsurance
- Verify benefit limit accumulators
- Check claim status
- Submit a professional or facility claim (free service through the Premera HMO payer)
- Submit and check the status of a prior authorization and referral
- View check and explanation of payment (EOP) information
- Register for electronic funds transfer for enrollment or cancellation using Premera and Affiliates as a health plan payer
Eligibility and benefits
Availity offers the quickest way to get secure, personalized, easy-to-use information. Providers can verify member eligibility and benefits (including plan effective dates), basic demographic information,
deductible, and benefit limit accumulators.
Sign in to Availity and select Patient Registration | Eligibility
and Benefits Inquiry. Select Premera Blue Cross HMO as the payer and complete the required fields to submit a request.
Prior authorization
Sign in to Availity to access the prior authorization tool for Premera Blue Cross HMO Core Plus. The Availity prior authorization tool considers a member’s eligibility and coordination of benefits. The status of these requests can be checked through the
Authorization & Referral inquiry tool or dashboard. If the request is denied, a letter will be mailed to the provider and member.
Sign in to Availity and select Patient Registration | Authorizations
& Referrals. On the Authorizations and Referrals page, select Authorization Request. Select Premera Blue Cross HMO as the payer and complete the steps to submit a request.
Referrals
An HMO member is required to have a referral for specialty services from their PCP who can guide them through the process. The referral tool is available in Availity. There are certain services that are direct access and don't require a referral. Review
the Direct Access Services List before submitting a referral.
Sign in to Availity and select Patient Registration | Authorizations
& Referrals. On the Authorizations & Referrals page, select Referral
Request. Select Premera Blue Cross HMO as the payer and complete the steps to complete a request. View Availity Quick Guide for online referral tools.
Code check tool
The code check tool only shows codes used for non-individual plan members (group and associates – includes Premera Blue Cross HMO) and doesn’t provide member-specific information. To access the tool, sign in to Availity, select Payer Spaces, look for the Premera HMO logo, and select the code check tool link under the Resources tab. You can also find the tool in Authorization & Referrals through Additional Authorizations and Referrals.
Check prior authorization and referral status
The status of a prior authorization or referral requests can be checked through the Auth/Referral inquiry tool or dashboard. If the request is denied, a letter will be mailed to the provider and member.
Sign in to Availity and select Patient Registration | Authorizations
& Referrals. On the Authorizations and Referrals page, select Auth/Referral Inquiry or Auth/Referral Dashboard and select Premera Blue Cross HMO as a payer.
Claims submission
Claims can be submitted daily, weekly, or monthly. The earlier claims are submitted, the earlier they will be processed. Ideally, claims should be submitted within 60 calendar days of the covered services, but no later than 365 calendar days from the
date of submission. Claims can also be submitted to Premera HMO through Availity Essentials for free.
Sign in to Availity In the Availity menu bar, click Claims & Payments | Claim to submit a professional or facility claim. Select Premera Blue Cross HMO as a payer for professional and facility claims.
Claims status
To see the status of a claim:
- Online: The best way to check claim status is to sign in to Availity. Information is available 24 hours per day, seven days per week.
- Customer service: If you don't have online access, contact customer service at 844-722-4661, or call the phone number on the back of the member's ID card.
- Interactive voice response (IVR): Available 24/7. IVR provides claims information.
Sign in to Availity and select Claims & Payments | Claim Status to search for a claim by date of service, Member
ID or claim number. Select Premera Blue Cross HMO as the payer.
Resources
In the Availity menu bar, select Payer Spaces and then select the Premera Blue
Cross HMO logo. Select the Resources or News and Announcements tables to access information specific to Premera Blue Cross HMO.
Provider online PCP roster tool
The PCP roster tool allows a provider to see a list of patients who selected them as their PCP or were assigned to them. A provider can search by TIN, provider, or clinic. The provider can download the roster to see all the information they need to know
about their patient(s).
Sign in to Availity and select Payer Spaces and then select the Premera Blue Cross HMO logo. Click on the
Resources tab and scroll down to the primary care provider (PCP) roster link to access the tool.
View Provider PCP Roster tool guide.
Electronic funds transfer for enrollment or cancellation
If a provider is already enrolled in electronic funds transfer (EFT) with Premera Blue Cross plans, no action is
needed to re-enroll through Availity. Premera still processes Availity transactions for EFT requests. However, new providers must enroll for EFT using Availity’s Transaction Enrollment Tool. Watch this how-to demo or view an EFT enrollment help topic.
Note: Use Premera and Affiliates as a health plan payer.
Remittance and Explanation of Payments (EOP)
To see a check and EOP information that Premera Blue Cross HMO submits to Availity, a check needs to be validated for Premera business and dated within the last 30 days. Only then can the check information and EOPs be made visible.
EOPs can be accessed through Remittance Viewer, which uses multiple data search points including claim number, check/EFT number, tax ID, NPI, member ID, patient control number, and payer name. View how to find EOPs.
Note: If searching by check/EFT number, use a payment reference number if registered for electronic funds transfer. Otherwise, search using the check number. The Premera HMO payer will not display in Availity until we get closer to January
1, 2023.
Sign in to Availity or register and get training. View our Availity provider FAQ for
more details.