New Code Check and Updated Eligibility and Benefits Tools

  • September 7, 2017

    On August 29, we added a new code check tool and launched several major enhancements and display features to our online eligibility and benefits tool.

    By enhancing this frequently used tool and adding a new one, we're supporting our company promise to make healthcare work better. Our goal is to save you time and provide accurate, real-time information, including reliable benefit information you can share with your patients.

    Improvements to our eligibility and benefits tool

    The newly simplified eligibility and benefits display gives you information that's easier to read. You can quickly find out if a service is covered for a patient, without having to call Premera for verification.

    These improvements mean you can now more easily read a member's plan information, including:

    • Effective date
    • Type of plan and network name
    • Deductible/max amount to date and exclusions
    • Primary care provider
    • Coordination of benefits
    • Search by member ID or name and date of birth
    • In-network vs out-of-network benefits, now more easily identified with a filtered view

    These are the first of many updates to come! We'll keep you informed via Provider News for the latest updates.

    Note: Quick access to our claims tool (located within the eligibility and benefits tool) will be temporarily unavailable. This functionality is scheduled to be back in place within the tool by early 2018, following the new claims tool launch. But, you can still get to this info by selecting claims and payments from your dashboard or left navigation menu.

    Code check tool: great resource for dental providers, too

    Our new code check tool helps you quickly check procedure codes to see if they require review, so you can continue to care for your patients without having to call us. This is an especially handy feature for our dental providers, who couldn't check this information online previously and always had to call for this information.

    The new code check tool includes all dental, medical, eviCore, and AIM codes, as well as unlisted codes if they require review.

    Which tool should I use to see if a code needs review?

    If you simply need general information about whether or not a code requires review, use the new code check tool. The code check tool will be available on our non-secure provider website and when you sign into our secure dashboard. If you need member-specific information, use our prior authorization tool.

    User guides, feedback

    Check out our online tool user guides to learn the new features in helpful, step-by-step screenshots. These tool updates are a direct result of provider feedback through user testing at provider offices, phone calls, and our Premera Listens online survey. If you have suggestions on our online tools, we encourage you to send us your feedback.

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