May 6, 2021
A signed member authorization is needed for appeals submitted on the member’s behalf.
Premera requires a signed member authorization for all appeals submitted on the member’s behalf. The member appeal form includes an authorization section for the member to
sign and date. Providers will need to coordinate the submission of appeals with the member as the signed member appeal form must be included with any supporting documentation or medical records relevant to the appeal. The member appeal form is located in the forms section of our provider website.
This applies to member appeals for the following situations:
- Pre-service denial
- Request to reduce member financial responsibility
- Example: Requesting to waive member's cost shares
- Claim denial deemed the member’s responsibility to pay
- Example: Benefit is an exclusion, investigational, or experimental
Appeals regarding your contracted rates or provider payments aren’t member appeals and don’t require member authorization.