Provider News

  • Availity Eligibility and Benefits Tool Enhancement

    Provider feedback leads to clear deductible instructions.

    Learn more

  • Policy updates


  • Online tools and resources

    Availity Eligibility and Benefits Tool Enhancement | 9/7/2023

    Provider feedback leads to clear deductible instructions

    New Availity Tips and Resources Tutorial | 9/7/2023

    Access the online video and user guide to get the most out of your Availity tools

    Reminder: Advanced Claims Editing Implementation | 8/3/2023

    The second-pass editor is applied after claims adjudication and prior to provider payment

    Provider Feedback Helps Us Improve Availity | 8/3/2023

    Get the latest Availity tips based on provider feedback

    Getting Diabetic Retinal Eye Exam Results into Medical Records | 8/3/2023

    An easy tool for documenting and sharing diabetic retinal eye exam results

    Reminder: New Claims Editor Launches on July 8 | 7/6/2023

    Our current Claims Editor/What If Tool will be replaced with Clear Claim Connection (C3)
  • More online tools and resources news

  • Medicare Advantage

    Medicare Advantage Code and Policy updates for September 2023 | 9/7/2023

    The Medicare Advantage policies and code list have been updated

    Medicare Advantage Transitions to Symphony | 9/7/2023

    Use Symphony to enter your prior authorization and referral requests

    Medicare Advantage Referral and Prior Authorization Tool Changes September 1 | 8/3/2023

    Symphony will streamline your workflows by improving online prior authorization and referral submissions

    Code and Policy Updates | 8/3/2023

    The Medicare Advantage policies and code list have been updated
  • More Medicare Advantage news

  • Individual plans

    Updated Individual Plan Tools and Resources Page | 5/5/2022

    We recently added news forms to the Individual Plan Tools and Resources page

    Changes for 2022 Individual Plans | 9/16/2021

    Premera Blue Cross will no longer be offering individual plans in Skamania and Wahkiakum counties

    Everything You Need to Know About 2021 Individual Plans | 1/7/2021

    See resources and training guides for 2021 Individual plans.
  • More individual plan news

  • Company updates

    2023 Provider Survey – Give Us Your Feedback! | 7/6/2023

    Please complete and return this important survey as quickly as possible

    Annual Risk Adjustment Data Validation Audit | 7/6/2023

    Provider offices may receive a request for medical records from Cognisight or directly from Premera

    Introducing Rx Savings Solutions | 6/1/2023

    A tool to help your patients control their prescription drug costs

    Premera Supports New Pediatric Residency in Spokane | 5/4/2023

    The program’s mission is to improve children’s overall healthcare and foster aspiring physicians

    EvergreenHealth and Premera Blue Cross have Reached an Agreement | 4/6/2023

    There will be no disruption for Premera members who receive care at EvergreenHealth

    AIM Specialty Health Transitioned to Carelon | 4/6/2023

    This is a name change only and will be no changes to the way providers submit requests or the contact information to check status
  • More company updates news

  • High-value care

    Value-Based Care and Premera Provider Relationships | 3/18/2021

    Relationships built on trust, shared data, and analytics can decrease cost of care and health outcomes.

    Payment Models Shift to Value-Based Care | 12/17/2020

    Healthcare organizations and health plans are shifting from care models built around fee-for-service reimbursement to value-based care.
  • More high-value care news

  • Reminders and updates

    Modifier 90 Reference/Outside Laboratory Policy Expansion to Include Facility Claims | 9/7/2023

    Facility claims submitting lab services with Modifier 90 will be denied reimbursement

    Notification of Recredentialing Completion | 9/7/2023

    Letters being sent to providers to inform them their recredentialing process is complete

    New Provider Customer Service Hours | 8/3/2023

    Provider customer service hours are now 6 a.m. to 5 p.m
  • More reminders and updates news

  • Quality programs

    September Care Gap Member Outreach | 9/7/2023

    Members may receive mailings on cancer screening and chronic conditions reminders

    Well-Child Member Outreach | 8/3/2023

    Premera will continue to send communications about the importance of well-child checkups

    Chronic Condition Member Outreach | 8/3/2023

    This summer, members will receive communications about monitoring their asthma and diabetic HA1c testing

    Talk to Your Patients About Osteoporosis After Fragility Fractures | 7/6/2023

    Tip sheets to learn more about the osteoporosis management in women who had a fracture (OMW) HEDIS®, including information about exclusions and best practices
  • More quality programs news

  • Pharmacy

    Makena and Hydroxyprogesterone Market Withdrawal | 5/4/2023

    The FDA announced the decision to withdraw the approval of Makena and Hydroxyprogesterone caproate injections on April 6, 2023

    Kroger is In-network for Premera Medical Advantage Plans | 2/2/2023

    Premera Medicare Advantage plans use CVS pharmacy as the pharmacy benefit manager

    Kroger- Express Scripts Termination Reminder | 1/5/2023

    We encourage members to sign in to the Premera member portal to find other local, in-network pharmacy options

    Kroger Removal from Express Scripts Standard Networks | 11/3/2022

    Learn about impacted pharmacies and how it may affect your patients
  • More pharmacy news

  • Dental

    Use “Premera Dental” as the Payer When Using Availity | 7/7/2022

    Learn some handy tips for using Availity’s secure provider website

    Submitting Medicare Advantage Dental Claims for Out-of-Network Providers | 5/5/2022

    Make sure your claims are going to the right place for processing

    Visit our Medicare Advantage Dental Website | 4/1/2022

    Resources to help you care for our Medicare Advantage members

    Have You Opted Out of Medicare? | 2/25/2022

    Information about providing care to Premera Medicare Advantage members

    Availity Tips for Dental Providers | 2/1/2022

    Learn some handy tips for using Availity’s secure provider website
  • More dental news

  • Premera Blue Cross HMO

    New Provider Systems Join the Sherwood HMO Network | 9/7/2023

    We welcome Virginia Mason Evergreen Health to the HMO network

    Update to Retrospective Requests for Premera Blue Cross HMO Referrals | 8/3/2023

    Premera will accept retrospective requests referrals up to 6 months after the date of service

    Specialty Services Referral Requirement | 7/6/2023

    Premera Blue Cross HMO members are required to obtain a referral prior to receiving specialty services

    Steps to Determine Premera Blue Cross HMO Network Status | 6/1/2023

    Finding out if you’re in the Premera Blue Cross HMO network can be simple

    Premera HMO must be Notified of a PCP Change | 5/4/2023

    Learn about the scenarios when a member needs to change their designated primary care provider
  • More Premera Blue Cross HMO news

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