Appeal Process for 2020 Individual Plans

  • December 19, 2019

    Evolent Health (Evolent) is managing all level one appeals and peer-to-peer reviews for Premera Blue Cross (Premera) 2020 Individual Plan members. Premera will handle level two appeals.

    To submit a clinical appeal on behalf of a patient (denied prior authorization), do one of the following:

    • Submit an appeal form by fax to 844-990-0262. The new appeal form will be on the provider secure site and the Premera non-secure website under “Forms” starting January 1, 2020.
    • Call customer service at 800-607-0546 to start an appeal process.

    To submit an appeal on a claim:

    • Call customer service at 800-607-0546 and they’ll provide you with instructions on how to submit an appeal letter.
    • To request a peer-to-peer review, call customer service at 800-607-0546 and they can direct you on how to speak with an Evolent medical director.
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