Contact Information, Confidentiality, and Appointment Access

  • Contacting us

    General Correspondence Headquarters
    Premera Blue Cross
    7001 220th St SW
    Mountlake Terrace, WA 98043-2124    		 Mailing Address
    PO Box 327
    Seattle WA 98111-0327
    Spokane

    Main Office
    Premera Blue Cross
    835 N Post St, Suite 301
    Spokane, WA 99201

    		 Mailing Address
    Premera Blue Cross
    PO Box 3048
    Spokane, WA
    992202-3048
    Mountlake Terrace
    (Seattle)     		Premera Headquarters
    Premera Blue Cross
    7001 220th St SW
    Mountlake Terrace, WA 98043-2124    		 Mailing Address
    PO Box 327
    Seattle, WA 98111-0327
    Calypso Overpayment Refunds
    (excludes NASCO)
    800-364-2991
    PO Box 327
    Mail Stop 229
    Seattle, WA 98111-0327    		 Subrogation Case Management
    888-704-0638
    PO Box 327
    Mail Stop 227
    Seattle, WA 98111-0327
    Electronic Claims
    (EDI)
    EDI@premera.com    		 Washington
    800-435-2715
    Fax: 425-918-4234
    PO Box 327
    Seattle WA 98111-0327
    Interest-related Questions Prompt Pay
    1-800-722-1471    		  
    Care Management 800-722-4714, option 3
    Fax: 800-866-4198
    PO Box 327
    Mail Stop 453
    Seattle, WA 98111-0327    		  
    Provider Appeals PO Box 91102
    Seattle, WA 98111-9202    		  
    Provider Information Changes Fill out form
    Email:
    provider.relations@premera.com
    Fax: 425-918-4937    		  
    Premera Blue Cross
    Blue Shield of Alaska    		 800-508-4722
    Centerpoint Drive, Suite 940
    Anchorage, AK 99503    		 Mailing Address
    PO Box 91059
    Anchorage, AK 99524-0906

  • BlueCard

    BlueCard Host

    BlueCard Eligibility Inquiries
    888-261-9562
    Fax: 425-918-4115

    800-676-BLUE (2583)
    PO Box 91059
    Seattle, WA 98111-9159

    NASCO

    National Account Service Company (NASCO)

    BlueCard Eligibility Inquiries
    800-713-5373
    Fax: 425-918-6986
    PO Box 91059
    Seattle, WA 98111-9159

  • Each contracted provider is assigned to a Provider Network Executive (PNE) or Provider Network Associate (PNA) at Premera. Call 877-342-5258 to speak with your PNE or PNA.

    The provider relations team can assist you with questions or issues related to your direct relationship with Premera. Please email them at provider.relations@premera.com and include your tax ID number, NPI numbers, and the names of the providers relevant to your request. Note that the team doesn’t have access to benefits, claims, or member account information. Contact us at provider.relations@premera.com for help with the following:

    • Address changes
    • Tax ID number updates
    • Telephone number changes
    • Clinic opening or closing
    • Additions to your clinic
    • Practitioner/dental retirement, etc.

    See self-service options on our contact us or learning center pages.

    Call Premera Blue Cross at 800-722-1471.

  • Confidentiality policy

    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 any and 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're required to maintain the confidentiality of all PPI concerning any current or former patients (our members). In addition, you're 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” isn't limited to 90 days, and such disclosures don't 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
    • 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

  • Provider Appointment Accessibility Standards including After-Hours Care

    Surveys and data collection to assess our members’ access to providers are done annually. Our provider appointment accessibility standards are based on requirements of the National Committee for Quality Assurance (NCQA) Accreditation Program, Washington Administrative Code 284-170-200(13) and applicable federal law. NCQA accreditation is required in order to sell plans in the Washington Health Benefit Exchange.

    Below are the standards for member access to care that we measure in our monitoring.

    Access to Appointments: Primary Care Providers

    Appointment Type Standard
    Regular or routine care appointments Within 10 business days
    Physical exams, preventive care Within 30 business days
    Urgent care Within 48 hours
    After-hours care Providers must provide coverage for their practices 24 hours a day, 7 days a week, with a published after-hours phone number to a pager, answering service, or recorded message directing members to a physician for after-hours care.

    Access to Appointments: Specialty Care Providers

    Appointment Type Standard
    Non-urgent appointments Within 15 business days
    Urgent care appointments Within 48 hours
    After-hours care Providers must provide coverage for their practices 24 hours a day, 7 days a week, with a published after-hours phone number to a pager, answering service, or recorded message directing members to a physician for after-hours care.

    Access to Appointments: Behavioral Health Providers

    Appointment Type Standard
    Behavioral health Within 10 business days
    Behavioral health: Urgent care Within 48 hours
    Behavioral health: Care for a non-life- threatening emergency Within six hours
    After-hours care Providers must provide coverage for their practices 24 hours a day, 7 days a week, with a published after-hours phone number to a pager, answering service, or recorded message directing members to a physician for after-hours care.

  • This Provider Manual is provided for informational purposes only and does not amend any applicable provider agreements. To the extent of any inconsistency, the applicable provider agreement and governing law will prevail. The Provider Manual doesn’t guarantee eligibility, coverage, authorization, reimbursement, or payment. Providers are responsible for verifying eligibility/benefits, obtaining required authorizations, and submitting accurate claims in compliance with applicable billing, coding, documentation, and regulatory requirements.

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