Providers Outside of Washington and Alaska

  • Prior Authorization

    We highly recommend that you submit a review request before providing the service. This helps us pay claims faster with no unexpected cost to you or the member after the services are provided.

    Sometimes a service requires prior authorization. If you don't get a prior authorization, it could result in a payment penalty to the member. Please note that you can't submit a prior authorization request by phone.

    When a service requires pre-service review, there isn't a penalty, but we'll hold your claim and ask for medical records.

    How does it work?

    1. Find out if a code needs review

    To see if we require a prior authorization or a pre-service review, you can use our code check tool for general code information.

    2. Submit a review

    Log in to the Blue plan's website in your service area to find tools for out-of-area members. They'll route you to our prior authorization tool where you can submit a request and attach your records all at once. Or, you can complete our pre-service review request form. Our medical policies are useful for checking coverage criteria.

    3. Check prior authorization review status

    After we receive all required materials, we typically respond with a decision within 5 business days. It may take up to 15 days if additional information is needed. Once we make a decision on a pre-service review request, we'll fax it to you. If we deny a prior authorization service, we'll mail a detailed letter to you and the member.

    Types of services

    For the best online experience with 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 website where you can submit authorizations for Premera members.

    Advanced imaging and radiation oncology

    AIM logo

    Visit AIM Specialty Health or call 866-666-0776.

    Outpatient rehabilitation

    EviCore logo

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

    Pharmacy

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

    Inpatient admissions policies

    When you admit one of our members, we require the hospital to let us know by calling 877-342-5258, option 3. This number is for admission notification only. Or you can fax us an admission notification request form. You can view inpatient admission notification policies to check which services require admission notification and learn what to do for urgent care situations.

    Emergencies and extenuating circumstances policy

    If an emergency prevents you from getting prior authorization, you must notify us within 48 hours following onset of treatment, or as soon as is reasonably possible.

    We know there can be situations that may make it impossible for you to get a pre-service before treating a patient, or to notify us within 24 hours of admission. In these situations, please contact us before submitting a claim. Follow the recommended practices detailed in the extenuating circumstances policy so that the claim isn't automatically denied.

    Eligibility, benefits, and claim status

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

    On behalf of Premera Blue Cross, AIM Specialty Health (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.