New Provider Onboarding

You’ll receive your credentialing welcome letter within a week of completing the credentialing process. For a copy of the letter, you can email credentialing.updates@premera.com. 

Once you’re notified of your contract effective date, you can begin seeing our members and submitting claims. (Note that your credentialing completion date is not the same as your contracting effective date.)

Sign in to Availity to verify eligibility and benefits and download a copy of the member's ID card. To see ID card examples, check out our ID Card Guide.

Register with Availity and get training. Visit our Availity Frequently Asked Questions page for additional resources and training.

Yes. Visit our Learning Center for online tools, user guides, and more.

You can also sign in to Availity where you'll find tool demos through the Help & Training link on the Availity homepage.

Not yet signed up with Availity? Visit the Availity registration page to sign up and access tools.

Yes, we have a behavioral health resources web page dedicated to information exclusively for our behavioral health and Applied Behavior Analysis (ABA), and mobile crisis providers.

Visit the claim submission and payments section of our medical manual for information about submitting claims and check out our telehealth claim submission guide. You can also access our payment policies for industry standard recommendations.

You can submit claims to us three different ways:

1. Electronically (preferred method): For details, visit Electronic Transactions and Claim Payer IDs.
   
   
2. Availity (no charge): Claim submission for medical, dental, and facility. Note: You don’t need to use Availity as a clearinghouse to use this feature. Sign in to Availity and select Claims & Payments | Claim to submit a professional, facility or dental claim.
   
   
3. Hard copy: You can submit paper claims on CMS-1500 or UB-04 forms. To speed claims processing, we use document imaging and optical character recognition (OCR) equipment to read your hard-copy claims. To ensure that OCR reads your paper claims accurately:
   • Use only red CMS-1500 forms (no photocopied forms).
   • Type forms in black ink (handwritten forms cannot be read by OCR equipment).
   • Don’t fold, staple, or tape your claim.
   • Be sure information lines up correctly within the respective fields (data that overlaps another field/box cannot be read accurately).
   • Don’t write or stamp extra information on the form.
   • Avoid white correction fluid and highlighting information.
     
     
   Mail your claims to:
   P.O. Box 91059
   Seattle WA 98111-9159

You can submit claims daily, weekly, or monthly. The earlier you submit claims, the earlier we process them. Ideally, we'd like you to submit claims within 60 calendar days of the encounter, but no later than 365 calendar days from the date of service. For most plans, we deny claims received more than 12 months after the date of service with no member responsibility. Refer to your contract for further claims submission information.

Denial information is available through Availity Claims & Payment > Claim Status. You'll see detailed information about why the claim was denied. You can also view your explanation of payment (EOP) through Remittance Viewer within Claims & Payment.

There are several resources to view claim denial information:

1. View the claim information within Availity Claims & Payment > Claim Status > Claim Status Details to view claim details along with denial rationale.
   
   
2. View your Explanation of Payment (EOP) through Remittance Viewer through Clams & Payment. For a list of reason codes, view the explanation of payment (EOP) message codes.
   
   
3. If your claim received a first-pass edit, enter a mock claim within our Clear Claim Connection (C3) tool; sign in to Availity and go to the Premera payer space through the Resources tab. You can also watch a C3 Claims Editor tool tutorial video or view a C3 Claims Editor guide.
   
   
4. Visit our coding resources web page for detailed information about our payment integrity and policies, claim editing, coding guidelines, and quality care.
   
   
5. If you still have questions about your claim denial, contact the customer service number on the back of the member’s card. 

Contact provider customer service at 800-722-4714 if you have questions about claims processing. You can also call the number on the back of the member's ID card.

The Premera explanation of payment (EOP) describes our determination of the payment for services. View the claims submission and payments section of our medical reference manual for an explanation of the EOP fields and descriptions of codes and messages.

Yes, we have a helpful coding resources web page featuring a wide range of tip sheets to support you in offering high quality member care and ensuring complete coding and documentation.

When sending in claims for billing, you must put the correct information in box 31 for the service you provided. If you have two licenses, you need to send a separate claim for each one, making sure to include the right details. If you forget to put the credentials, the claims will be processed based on what is listed in the NPPES registry. If this is why your claims are getting denied, you should send a corrected claim. If you submit claims electronically, contact your clearinghouse or software vendor for specifics on how to submit this information. If you submit claims by paper, the taxonomy code will be reviewed in box 24J. For any other questions, contact Premera EDI by email at EDI@Premera.com.

If you're a provider outside of Washington or Alaska seeing a Premera member, visit our providers outside of Washington and Alaska resource page.

If you're a Washington or Alaska contracted provider needing information to serve a Blue plan member from other states, visit our BlueCard provider resource page.

Other helpful resources include our BlueCard county map and BlueCard prefix list.

Use our provider contact list to get information about customer service, credentialing, provider relations, or visit our contact us web page.

Visit our Join Our Network web page to get specific information (based on specialty and credentialing status) about adding a provider under your contract. Providers must first be credentialed before becoming contracted providers.

Your counter-signed contract is loaded into our system based on the contract's effective date. The process can take up to 5 days once we receive the counter-signed contract. Custom or facility contracts can take up to 30 days.

Please allow 30 to 45 days for us to respond to your credentialing application.

To establish a contract in Washington, you must provide care primarily in Washington state. You may be eligible if practicing in an adjacent county bordering Washington state. If you live outside of our service area, you need to contact your local Blue Cross Blue Shield plan to establish a contract. Get more details on our Join Our Network page or if you have more questions, email us.

Credentialing is a background check of healthcare providers. Information is verified through a detailed application process by Premera in accordance with NCQA standards. A provider must be credentialed before requesting a contract.

A few key credentialing items to remember:

• You must complete re-credentialing every 3 years to avoid contract cancellation.
• Completing credentialing doesn’t mean you’re officially contracted with Premera and able to see patients.
• When you receive your fully executed contract (through DocuSign) you’ll have a copy of your contract and your official effective date.

Contracting is when a provider signs a contract to join a health plan's network. Contracts are based on the provider's tax ID number (TIN) and include everyone under the TIN. The contract status is linked to the tax ID number used on claims. All providers using this tax ID must follow the contract rules. Most contracts are automatically renewed annually.

Note: All the providers operating under a single TIN are in-network; specific providers can’t be excluded from the contract. Once you’re notified of your contract effective date you can begin seeing our members and submitting claims. (Your credentialing completion date is not the same as your contracting effective date.) The process to load a new contract can take up to 5 days to complete once we receive the countersigned contract.

Yes, we have a dental resources web page dedicated to information specifically for our dental providers. We also have a dental reference manual.

Requests for standard medical and dental fee schedules can be accessed through the Availity Fee Schedule Listing feature. Sign in to Availity, select Claims & Payment > Fee Schedule Listing to view standard medical and dental fee schedules. 

The tool accepts 25 codes at a time and requires you to select a network before entering codes. You can view the member’s ID card to confirm which network to select.

Dental providers must select Premera Dental as the payer and choose the Dental Choice network to view dental codes and select a medical network, such as Heritage, to display medical rates.

ABA and Behavioral Health resources
ADA code lists
Benefit booklets
BlueCard
Carelon
Claims editor tool
Coding
Code check tool
Dental
Dental reference manual
Drugs requiring approval
Find a Doctor (provider directory)
Electronic transactions, EDI
Electronic Funds Transfer (EFT)
Federal Employee Program (FEP)
Forms
ID Card Guide
Individual plans
Join Our Network
Learning Center
Medical and dental reference manuals
Medical policies
Payment policies
Plan prefixes
Prior authorization, code list
Provider contact list
Provider Networks Guide
Providers outside of WA/AK
Provider News
Update My Information

Electronic funds transfer (EFT) is a convenient way that Premera and its affiliates can pay providers through a direct deposit to their bank account. EFT eliminates paper checks, and lessens the potential risk associated with mailing checks. Visit our Electronic Funds Transfer web page for detailed information about registering for EFT.

Sign in to Availity and select Claims & Payment then Remittance Viewer to download a copy of your explanation of payment (EOP). If you can't see your EOPs, you first need to validate a Premera check. Need help? Select Manage Access at the top of the Availity Remittance Viewer page.

EFT is available for all Premera, Premera affiliate and Federal Employee (FEP) payments. Note that Shared Administration isn’t supported by EFT. For more information, visit our Payment and EOP Information web page.

We provide detailed information about our EOPs in our Provider Reference Manual. View the claims submission and payments section of our medical reference manual for an explanation of the EOP fields and a description of codes and messages.

If you’re missing payment, call provider customer service at 877-342-5258. Important: Sign in to Availity and select Claims & Payment > Remittance Viewer to download a copy of your explanation of payment (EOP). The EOP provides the payment information that customer service needs to assist you.

You can update your information with Premera by using our provider update form. Visit our Update My Info web page for a quick demo video.

Premera uses Quest Analytics’ BetterDoctor to verify your provider directory information. BetterDoctor will reach out to you quarterly to confirm or update your information. Get the details on our Update My Info web page.