July 6, 2023
Premera Blue Cross HMO requires that members obtain a referral from their HMO primary care provider (PCP) prior to receiving specialty services with a few exceptions. Claims submitted without an approved referral will be denied and members will be financially responsible for charges billed.
Specialty providers will receive a letter for approved referrals, but they can also view the status of a submitted referral via Availity.
To check the status of submitted referrals:
- Sign in to Availity and select Patient Registration | Authorizations & Referrals.
- On the Authorizations and Referrals page, select Auth/Referral Inquiry and select Premera Blue Cross HMO as a payer.
See the Direct Access Services list of exceptions where a referral is not required.
If you have referral-related questions, contact our dedicated customer service team for Premera HMO at 844-PBC-HMO1 (844-722-4661) or email hmoplusprovidersupport@premera.com.