Provider News

  • Prior Authorization Required for Hysterectomy Surgeries in 2022

    Prior authorization and site of service will be required for hysterectomy for dates of service January 7, 2022 and beyond

    Learn more

  • Policy updates

    News

  • Online tools and resources

    Provider Workshop: Credentialing | 10/7/2021

    On Wednesday, November 10 at 1:30 p.m., our provider relations team is hosting a workshop focused on credentialing

    Provider Workshop: Claims and Claims Editing

    Provider Workshop: Claims and Claims Editing | 9/16/2021

    Overview from the September 15 workshop

    Provider Workshop Overview: No Surprises Act | 8/5/2021

    Highlights, links, and resources from the July 21 No Surprises Act workshop

    Helping Members Make Informed Decisions | 8/5/2021

    Decision aids help patients understand their options for complex care scenarios
    Check Plan Type with Eligibility and Benefits Tool

    Check Plan Type with Eligibility and Benefits Tool | 7/1/2021

    Our online tool shows if a patient has a fully insured or self-funded plan

    Provider Virtual Workshop: No Surprises Act & Hot Topics | 6/3/2021

    On Wednesday, July 21, our provider network team is hosting a workshop on the No Surprises Act and other topics
  • More online tools and resources news

  • Medicare Advantage

    Benefit changes for 2022 Premera Medicare Advantage Plans | 10/7/2021

    Enhanced pharmacy, dental, acupuncture, naturopathic, and chiropractic services

    Remind Patients to Get a Mammogram | 9/16/2021

    Eligible Medicare Advantage members can get a mammogram every two years

    Updated Medicare Advantage Medical Policies | 8/19/2021

    Learn about the newest updates for Medicare Advantage policies

    Cognitive Assessment for Medicare Advantage Members | 8/5/2021

    Visits for a cognitive assessment are important for our Medicare Advantage members
  • More Medicare Advantage news

  • Individual plans

    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

    Avoid Claim Edits and Denials with These Helpful Tips

    Avoid Claim Edits and Denials with These Helpful Tips | 9/2/2021

    Upcoming expansion of claim editing affects professional and facility claims

    Availity Premera Provider Portal Launch Coming Soon | 8/5/2021

    Premera will have a single-source solution for all our providers through Availity’s secure provider portal

    Facility Claim Editing Expansion | 7/1/2021

    Starting this fall, Premera is expanding facility claim editing

    Enhanced Claim Editing for Professional and Facility Claim Editing | 7/1/2021

    Premera is enhancing professional and facility claim editing to ensure payment accuracy

    Premera Invests in Rural Health | 4/1/2021

    Premera granted $4.7 million to establish the Rural Nursing Health Initiative to place current students in rural practices in Washington state.

    Premera Team Reunites Member with Family | 3/18/2021

    Working with providers and medevac teams, Premera was able to help a member return to her family.
  • 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

    Prior Authorization Required for Hysterectomy Surgeries in 2022

    Prior Authorization Required for Hysterectomy Surgeries in 2022 | 10/7/2021

    Learn about an important change to our preventive care benefits for pre-exposure prophylaxis

    Update to PrEP Preventive Services Coverage | 9/16/2021

    Learn about an important change to our preventive care benefits for pre-exposure prophylaxis

    Inpatient Stays will Require Pre-certification for FEP Members | 9/16/2021

    If a precertification isn’t done for FEP inpatient stays, payments will be reduced

    New Payment Policy: Therapy Assistant Modifiers | 9/16/2021

    Physical therapy and occupational therapy assistant modifiers now required
  • More reminders and updates news

  • Quality programs

    Fall Care Gap Member Outreach | 10/8/2021

    Results from the provider survey on the collaboration of primary care and behavioral health practitioners

    2020 Practitioner Survey: Medical and Behavioral Health Collaboration | 9/16/2021

    Results from the provider survey on the collaboration of primary care and behavioral health practitioners

    Member Outreach Addressing Care Gaps | 8/19/2021

    Premera is reaching out regarding care gaps in diabetes, emergency department utilization, and colorectal cancer screenings

    In-Home Health Screening Kits for Medicare Advantage Members | 8/5/2021

    Premera will send in-home health screening kits for members with care gaps
  • More quality programs news

  • Pharmacy

    Pfizer Voluntary Recall of Chantix Lots | 8/19/2021

    Patients have been advised to consult with their doctor to confirm if they received an affected lot
    New Pharmacy Prior Authorization Required on July 1, 2021

    New Pharmacy Prior Authorization Required on July 1, 2021 | 5/14/2021

    Soolantra will require prior authorization on July 1, 2021. Find out more

    Voluntarily Recall on NP Thyroid®, Thyroid Tablets, and USP Lots | 5/14/2021

    NP Thyroid®, Thyroid Tablets, and USP lots recalled because testing found them to be sub-potent
    What’s the Difference Between Cologuard and FIT Kits?

    What’s the Difference Between Cologuard and FIT Kits? | 3/4/2021

    We encourage you to support colon cancer prevention and keep cost information in mind when recommending at-home colon cancer screening.
  • More pharmacy news

  • Dental

    Reimbursement Changing from Preparation Date to Seat Date | 9/16/2021

    Premera/LifeWise is changing payments for certain dental services

    Use Medical Codes and Forms to Expedite COVID-19 Vaccine Claims | 5/6/2021

    To get your claims paid more quickly, use COVID-19 vaccine medical codes

    New Payment Policy: Tele-dentistry Services | 3/18/2021

    Dental services are approved to be provided through tele-dentistry.

    New Medicare Advantage Dental Form and P.O. Box | 1/21/2021

    The form has easy-to-follow instructions and a new PO Box address for submitting claims.

    Answers to Common Dental Questions | 11/19/2020

    Frequently asked questions, helpful dental links, and more dental resources available in one place.
  • More dental news

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