Providers Outside of Washington and Alaska

  • Eligibility, benefits, and claim status

    Sign in to your local Blue plan's website. They pay the claim on our behalf and have the most current status.

    If you’re signed up with Availity, and the local Blue plan in your state is contracted with Availity, you can check eligibility and benefits, submit prior authorizations and check status, and submit a claim and get status for Premera members. Just select Other Blue Plans or Your Local Blue Plan and enter the member ID (include the prefix).
    If you’re a dental provider, select Premera Dental from the Availity payer list (available in all states). Premera uses the United Concordia Advantage Plus Network for out-of-state dental members. 

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    Prior authorization

    A service may require prior authorization. If you don't get a prior authorization, it could result in a payment penalty to the member. When a service requires pre-service review, there isn't a penalty, but we'll hold your claim and ask for medical records. Prior authorizations can't be submitted by phone.

    Choose Premera as the Payer in Availity
    Providers outside of Washington or Alaska can use their current Availity state to submit prior authorizations. Premera Blue Cross is listed as a payer for Authorizations & Referrals in all states.

    How to submit prior authorization

    1. Find out if a code needs review

    Sign in to Availity and use our code check tool to see if we require a prior authorization or a pre-service review.  

    2. Submit a review for prior authorization and pre-service review:

    The fastest way to receive a response is to sign in to Availity. Use your current Availity state to submit prior authorizations. Premera Blue Cross is listed as a payer for Authorizations & Referrals in all states.

    You can also sign in to your service area's Blue plan website to find tools for out-of-area members. They'll route you to our prior authorization tool where you can complete your request.

    Lastly, you can fax a completed request form.

    Our medical policies are useful for checking coverage criteria.

    3. Check review status

    Sign in to Availity and check the status of your request online through the Auth/Referral Dashboard or Auth/Referral Inquiry. We typically respond within 1-2 business days, but it can take up to 5 days. Once we make a decision on your review request, we'll fax it to you. If your review request is denied, we'll mail a detailed letter to you and the member.

    Advanced imaging and other services

    For the best online experience with Carelon Medical Benefits Management (formerly AIM) and eviCore, start by logging in to the Blue plan’s website in your service area to find tools for out-of-area members. You’ll be routed to their websites where you can submit authorizations for Premera members.

    Advanced imaging and radiation oncology

    Visit Carelon Medical Benefits Management or call 866-666-0776.

    Outpatient rehabilitation

    Visit eviCore healthcare. View Premera's list of codes that need review.


    Use our Rx search tool to see if a drug requires prior authorization.

    Inpatient admissions policies

    View inpatient admission notification policies to see which services require admission notification and what to do for urgent care situations. If notification is required, complete the admission notification request form and fax it to 888-742-1487.

    Emergencies and extenuating circumstances policy

    If an emergency prevents you from getting prior authorization before treating a patient or notifying us of admission within 24 hours, you must notify us within 48 hours following onset of treatment, or as soon as reasonably possible by calling 877-342-5258, option 3. This number is for admission notification only. You can also fax us an admission notification request form.

    In these situations, contact us before submitting a claim. Follow the recommended practices detailed in the extenuating circumstances policy so the claim isn't automatically denied.

    On behalf of Premera Blue Cross, Carelon Medical Benefits Management (formerly AIM) is an independent company that manages imaging services for Premera.
    On behalf of Premera Blue Cross, eviCore healthcare (formerly known as CareCore National) is an independent company managing outpatient rehabilitation services for Premera providers.