New Provider Agreement FAQ

The new provider agreement is the updated standard agreement for contracted providers. It defines key legal, operational, payment, billing, credentialing, compliance, network participation, and administrative requirements.

We are implementing it to create a more consistent and modern contract structure across provider agreements. It helps meet regulatory and accreditation requirements, clarifies provider and health plan responsibilities, aligns Premera’s contract with those of our competitors, and supports a more standardized and efficient contract structure.

For providers already in the Premera network, the agreement starts 90 days after Premera provides notice. For most providers, this will be in November 2026.

For new providers joining the Premera network, start dates begin this summer.

It will take several months to update all contracts. Check your agreement for your start date.

The information on this page applies to Washington providers with standard medical contracts.

In the coming months, it will also apply to providers with custom agreements and dental providers in the Premera network. Updating all contracts will take several months.

This change applies to all Washington Premera plans and lines of business.

Providers already in the network will receive documents that work together to replace and modernize their existing contract: the Amendment to Plan Provider Agreement and the Plan Provider Agreement.

The amendment serves as legal notice that Premera is restating the provider's existing contract and prior amendments. Beginning on the effective date, the new agreement becomes the governing contract.

Providers will also receive compensation exhibits, network attachments, and fee schedule addendums when applicable.

Starting in late July 2026, providers newly contracting with Premera will receive the updated Plan Provider Agreement.

Providers with an existing contract with Premera do not need to sign or return the contract documents. Premera is making this update through a unilateral amendment and restatement process, which it is contractually authorized to use because reimbursement rates and fee schedules are not changing. This approach was presented to and approved by the Washington Office of the Insurance Commissioner (OIC).

Providers who are newly contracted with Premera and providers on custom contracts will need to sign and return their contracts.

In most cases, Premera sent the contract to the email address we have on file for the provider clinic or organization. We worked to ensure we had the best email address to receive contract updates.

The email will come from contractautomation@premera.com via Docusign.

If you believe you should have received a contract via email and did not, check your spam folders and check with others in your practice before contacting provider relations at provider.relations@premera.com. Use “PROVIDER AGREEMENT” in the subject line and include their Tax Identification Number (TIN) to avoid a delayed response.

If we do not have a working email address for you, the contract is being sent via certified mail.

In addition to sending the agreement to providers, Premera published information about the agreement in Provider News, on our websites, and in the Availity portal.

A provider that is currently contracted under both a facility agreement and a professional agreement will, in the future state, have a single Plan Provider Agreement. Reimbursement terms will remain separate and unchanged.

The provider agreement will not impact existing reimbursement or rates. 

Fee schedules are available through Availity. They are no longer distributed directly by the Provider Relations team. Please sign in to Availity to access current fee schedule and reimbursement information. Providers will continue to receive notice of fee schedule changes prior to the effective date, in accordance with notification requirements.

For additional assistance, please refer to the Medical Fee Schedule or Dental Fee Schedule how-to videos, or visit the Availity Support page.

Overall, the new agreement aligns Premera’s contract with those of our competitors; implements stricter operational timelines, especially for claims; and expands compliance and administrative expectations.

Yes, the new agreement includes changes to claims and payments that affect providers, including:

• Providers must use required electronic systems (such as Availity).
• Claims must be submitted within 90 days (or 60 days for coordination of benefits).
• Providers must refund overpayments within 30 days. After that, the plan may offset any amounts owed.

The provider agreement does not include specific changes to prior authorization requirements. You must continue to follow plan rules, including administrative, medical, and payment policies. You must also participate in electronic prior authorization submission processes.

You’ll follow the same process as with your current agreements. As a reminder, this means:

• Use the plan-designated website or portal for all credentialing applications.
• Meet the plan’s credentialing standards and cooperate with credentialing and recredentialing.
• Give prompt written notice of material changes, such as changes to licensure, ownership, business address, tax ID, or new providers or entities that could affect their ability to provide services.

The agreement requires you to give timely, accurate, and complete demographic information so we can meet federal, state, and local provider directory requirements, as well as our own regulatory and accreditation requirements.

You must also give prompt written notice of changes, such as ownership, business address, tax ID, new providers or entities, or other material updates. To update provider information, use the Provider Update Form and reference the details on the Update Provider Information web page.

Providers are responsible for any losses that result from not providing timely, accurate, and complete provider directory information.

Some operational provisions of the new agreement will be phased in months after the contract goes into effect as Premera completes the system work associated with some of the changes.

This phased rollout does not waive, modify, or limit any rights or obligations under the agreement. Premera Blue Cross reserves all rights and intends to enforce the provisions once operational. We will provide advance notice before the system changes go into effect.

Premera encourages providers to review their contracts carefully and ensure your billing and administrative workflows align with these updates.

We value your participation in our networks and understand you may have concerns about the new provider agreement. Premera developed it after significant research into provider agreements used by other health plans in Washington.

If you want to terminate your contract prior to the effective date of the new agreement, you’re required to provide Premera with a written 90-day notification. If you want to terminate once the new agreement is effective, you’re required to give a written 180-day notification. Providers on custom contracts will need to refer to their contract for termination language.

To terminate your contract, complete the provider update form and email Physician and Provider Relations at provider.relations@premera.com. Use “PROVIDER AGREEMENT” in the subject line to avoid a delayed response.

If you submitted your contract termination and received an email response, your termination effective date remains the same as in that email.

If your termination takes effect after November 1, 2026, the new agreement will apply until that termination date.

For provider agreements issued unilaterally by Premera, the new agreement takes effect on the date specified in the agreement. Providers cannot remain on a previous agreement indefinitely or decline the new agreement while keeping the terms of the previous agreement.

If you don’t want to continue, the contract’s termination provision may apply.

Providers on negotiated contracts should discuss their questions or concerns with their assigned provider representative.

A Location Addendum lists the provider locations covered under a Premera agreement. Accurate location information helps meet CMS requirements, maintain an accurate provider directory, support claims accuracy, protect member access, and comply with federal, state, and contractual requirements.

The addendum will include the physical locations covered by the provider contract and verified during contract negotiations or through provider update form submissions.

For virtual care providers, if you told Premera that your practice location is your home address, your home address will appear on the Location Addendum. However, it will not appear in the member-facing provider directory.

To update location information, complete the provider update form and email Physician and Provider Relations at provider.relations@premera.com. Use “PROVIDER AGREEMENT” in the subject line to avoid a delayed response.

We do not mail printed copies of provider agreements. You can print a copy of your agreement for your records.

If you have questions after viewing this FAQ, email Physician and Provider Relations at provider.relations@premera.com. Use “PROVIDER AGREEMENT” in the subject line and include their Tax Identification Number (TIN) to avoid a delayed response.