ALERT: (September 19, 2023)
To ensure uninterrupted electronic funds transfer (EFT) payments, Individual plan network providers must sign in to InstaMed to confirm their NPI(s) are accurate, current, and match the correct TIN by December 1, 2023.
The individual plan website is managed by Evolent Health for Premera and uses tools specifically for patients with individual plans. If a member has an individual plan, their ID card will say Individual Plan.
View a sample
member ID card.
View prefix list for Individual Plans.
Sign in now
Note: Google Chrome is the best browser to use for the individual plan website.
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. Care notes, phone
numbers, and fax numbers are required fields on the Identifi prior authorization tool.
Once you log in, 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.
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:
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.
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.
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.
Check out our COVID-19 FAQ for the lasted updates on prior authorization.
Use the following provider training guides to learn more about our individual plan tools:
Search for medical providers, facilities, and other specialists within the Premera Blue Cross Individual Signature network.
Complete a provider
update form if you have any office changes.
Learn about our programs that help members navigate the healthcare system and manage their health.
Review our individual plan policies on our policy page.
Individual plans have a specific code list and InterQual criteria when reviewing certain services.
Individual plan forms:
Visit our forms page for all other provider documents.
Call customer service at 800-607-0546 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. Customer service can also provide web support and information on member eligibility and benefits.
Individual plan claims, appeals, and other paper correspondence must be sent to:
Premera Blue Cross PO Box 21702 Eagan, MN 55121
Call 844-996-0329 or fax 888-302-9325 to contact our utilization management team. Use this fax number to submit a prior authorization request.
InstaMed delivers all electronic funds transfer (EFT) payments and electronic remittance advice (ERA) for individual plans. If you submit and receive EFT/ERA through a clearing house, the clearing house needs to sign up for InstaMed. This process is not
completed by Premera EDI. Providers should be enrolled with InstaMed and Premera EDI to ensure they receive all Premera electronic remittance reports.
Great! You’ll automatically receive EFT payments for our individual plan claims.
You have 2 simple ways to sign up:
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