February 1, 2017
Premera's PersonalCare Plans require customers to select a primary care provider (PCP) and a network, known as a Partner System. Customers only see providers within their selected network and are referred by their PCP for care. That's why it's important for our providers to check the patient's network and eligibility before providing care or making referrals.
You can use your patient's ID card or our online tools to identify your patient's Partner System network. The patient's PersonalCare Plan card includes the name of the PersonalCare Partner System and PCP they selected.
Tips for online tools
Once you've pulled up the patient's information in the Eligibility and Benefits tool, look under Plan Eligibility for the name of their network. If they're part of a Partner System, you'll see the name of the Partner System listed here. In the screen shot provided, the patient has the Virginia Mason Medical Center Partner System network.
You should also look under Plan Messages. There you'll see a message indicating that the patient is on a PersonalCare Plan and their PCP information.
A few reminders about how these plans work:
- We only offer PersonalCare Plans in Snohomish, Pierce, and King Counties.
- Our customer's PCP is responsible for coordinating referrals within the Partner System network.
- When a customer is seen outside of their Partner System network, their PCP can refer them within the Heritage Signature/Prime network. Those referrals must be submitted to Premera in advance.
- Not all services require a referral. Check out the full list of services that don't require a referral.
Our 2017 PersonalCare Plan Partner Systems are:
- EvergreenHealth Partners
- MultiCare Connected CareTM
- Northwest Physicians Network
- The Everett Clinic Integrated Care Network
- UW Medicine Accountable Care Network
- Virginia Mason Medical Center
If you have any questions about this article, call Physician and Provider Relations at 877-342-5258, option 4.