Individual Plan Tools and Resources

News and updates for individual plans

Identifi

You can submit a prior authorization for Premera Individual plan members using the Identifi online submission tool or you can fax the prior authorization form. View code list.

Access Identifi to submit a prior authorization request. Important: To prevent delays, check the prior authorization code list before submitting a request to see if review is required or should be submitted through AIM.

It takes 1-5 business days to process your access to Identifi. If you need to submit a prior authorization during the waiting period, which automatically starts once you've clicked on the link to the Individual Plan secure provider portal, you can fax your submission or call our utilization management team. You can also call the customer service number on the back of the member ID card. You'll receive a confirmation email once you have Identifi access.

Individual Prior Authorization Tool Update

As of June 28, 2021, care notes, phone numbers, and fax numbers are required fields on the Identifi prior authorization tool.

Sending refund checks to Premera

A form isn't needed for sending us refund (overpayment) checks. You can submit requests in writing and include the following related to the overpayment:

• Member first and last name and ID number
• Date of service
• Amount and reason for refund
• Primary explanation of payment (if related to coordination of benefits)
  
  Mail provider refund checks to:
  Premera Provider Refunds
  P.O. Box 840571
  Los Angeles CA 90084-0571

Secure website error message

If you received the message, "You have successfully logged into the Evolent application, but we do not find the Provider," read these instructions to provide key services to your individual plan patients.

Secure member eligibility search

The member eligibility search doesn’t accept member prefixes. Search by member ID or by the member’s last name and date of birth for accurate results.

CMS 1500 online claims submission not available

The online claims submission tool for HCFA (CMS) 1500 claims currently isn’t available on the individual secure website. In the meantime, submit claims by mail to the address below or through Office Ally.

For professional and institutional claims, the claim payer ID is 00430 and for dental claims the ID is 47570.

COVID-19 prior authorization updates

Check out our COVID-19 FAQ for the lasted updates on prior authorization.