Provider News

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)

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

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.

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

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.

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

Consultation Code Services Payment Policy Expanding to Include Alaska Providers | 9/7/2023

New policy takes effect December 11, 2023

New Provider Customer Service Hours | 8/3/2023

Provider customer service hours are now 6 a.m. to 5 p.m

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

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

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

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