Provider News

  • Keep Your Provider Data Current

    Information to help you ensure you’re meeting federal requirements for provider data.

    Learn more

  • Policy updates


  • Online tools and resources

    Everything You Need to Know About Your Explanation of Payment | 2/2/2023

    The Explanation of Payment (EOP) gives you information about the adjudication of your claims

    Tool for Documenting Diabetic Retinal Eye Exam Results | 2/2/2023

    Assist your patients in getting their diabetic retinal eye exam results

    Latest Update to Availity Provider Feedback | 1/5/2023

    Our responses to your feedback from customer service calls, provider support teams, and Availity's online feedback feature

    2023 ID Card Guide | 1/5/2023

    Check out the newly updated 2023 Premera ID card guide

    Premera Teams Respond to Availity Provider Feedback | 11/3/2022

    Our responses  to your feedback from customer service calls, provider support teams, and Availity's online feedback feature

    Provider Workshop: Premera HMO Core Plus | 10/6/2022

    A training on the Premera HMO Core Plus plan product is December 7th -  save the date
  • More online tools and resources news

  • Medicare Advantage

    Encourage Medicare Advantage Patients to Get Screened for Colorectal Cancer | 3/2/2023

    Tips for what information to include in medical records, codes for patient claims, and tips for talking with patients

    Understanding Star Ratings - How are CMS star ratings determined? | 3/2/2023

    Understanding Star Ratings - How are CMS star ratings determined?

    Updates for Medicare Advantage Policies and Codes | 3/2/2023

    The Medicare Advantage policies and code list have been updated

    Medicare Advantage Members’ Annual Wellness Exams | 2/2/2023

    These visits play an important role in helping your patients maintain or improve their health through disease prevention and detection
  • 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

    Rural Healthcare Brings Challenges and Rewards | 1/5/2023

    Premera is working with the University of Washington to address the urgent need to improve access and health outcomes for rural populations by developing a pipeline of primary care in rural Washington state

    Supporting Providers in the Health Equity Journey to Improve Patients’ Lives | 10/6/2022

    Premera is working to reduce disparities in health and its determinants that adversely affect excluded or marginalized groups

    Premera Invests $3 Million to Bridge Gaps in Mental Health and Health Equity Access | 9/1/2022

    Premera announced $3 million in grants and sponsorships to 20 organizations across Washington and Alaska

    New Premera HMO Plan | 9/1/2022

    Our HMO plan will provide services to members in Pierce, Thurston, and Spokane counties

    Premera Perspectives: Satya Sarma, Vice President of Medical Management and Population Health | 5/5/2022

    Learn about Premera’s newest leader and her role to identify ways to address the needs of specific communities

    Premera Invests $1.8 Million to Help Washington Colleges Address Critical Nursing Shortage | 5/5/2022

    Grant establishes a new academic pathway to increase opportunities and remove barriers
  • 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

    AIM Specialty Health Transitioned to Carelon | 3/2/2023

    AIM Specialty Health changed its name to Carelon Medical Benefits Management on March 1, 2023

    How To Submit Admission Notification | 3/2/2023

    Inpatient admission notification helps in getting your claims paid correctly and on time

    Keep Your Provider Data Current | 3/2/2023

    Information to help you ensure you’re meeting federal requirements for provider data

    AIM Specialty Health Transitions to Carelon | 2/2/2023

    AIM Specialty Health will have a new name, Carelon, on March 1, 2023
  • More reminders and updates news

  • Quality programs

    Advanced Illness and Frailty Exclusions Allowed for HEDIS® Star Measures | 3/2/2023

    Some patients can be excluded from select HEDIS® star quality measures due to advanced illness and frailty – learn the criteria and codes

    Helping Patients Who Use the Emergency Department for Migraines | 3/2/2023

    Learn about informative migraine materials you can share with your patients

    Outreach Mailings to Members with Children | 2/2/2023

    Premera is reaching out to members to keep children on track with vaccines and checkups

    High Blood Pressure Educational Mailing | 12/1/2022

    Premera is providing members with winning tips for a healthy heart
  • More quality programs news

  • Pharmacy

    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

    2023 Essential Drug Exclusion List | 11/3/2022

    Starting January 1, 2023, some drugs will change to preferred status, and some have been added to the Essential Drug Exclusion List
  • 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

    Use Availity to Submit Premera HMO Referrals | 3/2/2023

    Learn about the fastest way to submit referrals

    Want to learn more about Premera HMO Core Plus? | 3/1/2023

    The HMO provider resources page has more information and resources about the plan

    Premera Answers Top Questions about HMO Core Plus Plan | 2/2/2023

    Read the latest FAQ for Premera HMO

    Premera Blue Cross HMO Core Plus Plan – Availity Trainings Now Available | 12/1/2022

    Sign up for Availity webinar trainings today

    Provider Workshop: Learn About Premera HMO Core Plus | 11/3/2022

    We'll share Premera HMO Core Plus resources, plans details, and tips at the Provider Workshop
  • More Premera Blue Cross HMO news

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