Prior Authorization Process Changing for Premera’s 2020 Individual Plans - Updated Information!

  • December 12, 2019

    Everything you need to know about 2020 prior authorizations

    There are important process changes to submitting prior authorization requests for your patients with Premera Blue Cross Blue Shield of Alaska (Premera) 2020 Individual health plans.

    Prior authorizations requests submitted through 12/31/2019:

    • Providers will use the current 2019 code list on the Premera website to see if prior authorization is required. To submit a request, fax the current prior authorization form under "Forms" to Care Management at 800-843-1114.

    Prior authorizations submitted on/after 1/1/2020:

    • There will be a new code list for Individual plans and most services will require prior authorization.
    • You have two ways to submit prior authorizations:
      1. Online using Evolent’s prior authorization submission tool, Identifi, on the provider secure website.
        • You aren’t required to register with Identifi to start using it in January.
        • Once you sign into your OneHealthPort account on/after January 1, 2020 and click to access the new Premera 2020 Individual Plan site, you’ll be granted access to Identifi within 1-5 business days. You’ll receive a confirmation email once your access is granted. There aren’t any additional steps you need to take. If you need to submit a prior authorization during the 1-5 day waiting period, you can fax your submission using the instructions below, or call our utilization management team directly.
        • For questions about Identifi, our utilization management staff can answer your questions beginning on 1/1/2020 at our customer service line, 800-809-9361.
        • You can also look at our step-by-step training on how to use Identifi.
      2. Fax a new prior authorization submission form available on the Premera website under “Forms” and on the Individual secure site starting 1/1/20.
    • Individual market health plans aren’t using eviCore for outpatient prior authorizations. See our separate provider news story for more information on this.
    • Individual plans are using AIM Specialty Health for imaging prior authorizations.

    Prior authorization requests spanning 2019-2020:

    We understand there may be patients with existing/approved prior authorizations in 2019 for services in 2020. Our medical management team is tracking these cases and will follow the below protocol for prior authorizations spanning the plan years:

    • If the serving provider in 2020 is in-network and the benefit is covered then we’ll honor the 2019 prior authorization.
    • If the serving provider in 2020 is now out-of-network, the serving provider will need to submit a new prior authorization using the new code list. This scenario will be rare since the AK Individual market network isn’t changing. Medical management will fax back the provider if a new prior authorization is needed.

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