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 for Premera members as well as submit a claim and get claims status. Just select Other Blue Plans or Your Local Blue Plan and enter the member ID. If you’re a dental provider, select Premera Dental from
the payer list.
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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.
Note: Prior authorizations can't be submitted by phone.
Use our code check tool to see if we require a prior authorization or a pre-service review.
For prior authorization and pre-service review: 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 submit a request and attach your records all
You can also fax in a completed request form. Our medical policies are useful for checking coverage criteria.
After we receive all required materials, we typically respond within 5 business days. It may take up to 15 days if additional information is needed. 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.
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 websites where you can submit authorizations for Premera members.
Visit AIM Specialty Health or call 866-666-0776.
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.
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.
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
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.