Contact Information and Confidentiality Policy

Provider network representatives (PNR) handle your requests and resolve issues. Email provider.relationswest@premera.com to help with:

• Panel updates
• Address changes
• Tax ID number updates and ownership changes
• Telephone number changes
• Clinic opening or closing
• Malpractice insurance changes
• Directory copy requests
• Practitioner adds and terminations to your clinic
• Questions about OneHealthPort or Availity
• Questions on a physician/provider mailing
• Practitioner retirement notice
• Document copy requests (e.g., contract copies, provider communications, manuals, etc.)

Each contracted provider is assigned to a PNE or PNA at Premera. You can email contracting questions to provider.relationswest@premera.com. The Provider Relations team will assist and can direct you to your PNA as needed. These teams can assist with the following:

• Policies and procedures
• Practitioner contracting
• Network adequacy
• Contract status inquiries

800-562-1011
Fax: 425-918-5338
PO Box 33932
Seattle, WA 98133

Our confidentiality policy protects the confidentiality and privacy of our members' protected personal and medical information by preventing the unauthorized use and disclosure of such information by our associates and business associates.

Protected Personal Information is all information created or received by the company that identifies or can readily be associated with the identity of an individual, whether oral or recorded in any form or medium, that directly relates to the:

• Past, present, or future physical, mental, or behavioral health or condition of an individual
• Past, present, or future genetic information of the individual or their dependent, or relative of either
• Past, present, or future payment for the provision of healthcare to an individual
• Provision of healthcare to an individual
• Past, present, or future finances of an individual, including, without limitation, an individual's name, address, telephone number, Social Security Number, subscriber number, or wage information

We're committed to maintaining the confidentiality of individuals' protected personal health and financial information (collectively referred to as “protected personal information” or PPI). Premera collects, uses, and discloses PPI solely for routine business functions or as required or permitted by law or regulation. We strictly prohibit the unauthorized disclosure of PPI by our associates and business associates unless we have first obtained the member's written authorization.

We understand that you value standards of confidentiality as a healthcare professional. As a contracted physician or provider, you are required to maintain the confidentiality of all PPI concerning any current or former patients (our members). In addition, you are also bound to observe certain state and federal privacy laws. At a minimum, each clinic should have each staff member sign a confidentiality statement upon employment in which the employee acknowledges the importance of maintaining the confidentiality of PPI. This is a Premera office site standard used in our credentialing and recredentialing process.

The “authorization for treatment” that you obtain from Premera members prior to rendering services, authorizes you to disclose general health information to us. The validity of such an “authorization for treatment” is not limited to 90 days, and such disclosures do not need to be documented in the member's medical chart.

State and federal privacy laws allow physicians and providers to disclose PPI to Premera without the patient's authorization for payment purposes and healthcare operations such as:

• Determining eligibility
• Paying claims
• Coordinating benefits with other insurance carriers
• Utilization and medical/dental necessity reviews
• Healthcare operations activities (e.g., case and care management, quality reviews)

Any activity undertaken by the company, or by a business associate on behalf of the company, for healthcare operations and payment activities:

• Carrying out the management functions of the company, examples include: underwriting, actuarial, care management, case management, and quality reviews
• Obtaining subscription charges
• Determining or fulfilling its responsibility for coverage under the health plan and for the provision of benefits under the health plan, examples include: member benefit eligibility, payment of member claims, and coordination of member benefits with other insurance carriers or liable third parties