Electronic Claims Overview

Submit claims using a clearinghouse or to Premera directly

We currently partner with many EDI clearinghouses and vendors. We can add a new clearinghouse upon review and approval. A clearinghouse acts as a go-between for the provider and the payer (health plan). Using a clearinghouse means you can reach multiple payers through a single vendor.

Submit directly to Premera EDI (not using a clearinghouse)
Before you enroll, you'll need to check with your system vendor to confirm that your system can send in the HIPAA (x12)-required format. This option is typically used by large Facilities, large provider groups and billing services.  Please email us for more information.

Submit using a clearinghouse
You can submit electronic claims to Premera EDI using the clearinghouse of your choice or the choice of your software vendor if the clearinghouse is enrolled with us. Please check with your clearinghouse or software vendor on how to submit an electronic claim to Premera EDI. 

Claims can be submitted to Premera through Availity for free using Premera plans as a payer through Availity Essentials. Select Claims & Payments > Claims & Encounters to submit a professional, facility, or dental claim. If you're a dental provider, you have the option to submit a claim or a predetermination request to Premera.

How will I know if my electronic claim was accepted or rejected?
We create an accept/reject report that we share with our direct submitters and clearinghouses. Check with your clearinghouse about receiving reports.

NOTE:  Make sure your National Provider Identifier (NPI) is submitted on your electronic claim. If you are a dual licensed provider, please ensure the appropriate taxonomy code is submitted on your claim. Taxonomy codes will need to be registered on the NPPES website. If you have questions or need to update your provider record to include your taxonomy code(s), contact NPPES at 800-465-3203.

Premera accepts claim transactions for the following plans:

• Premera Blue Cross
• BlueCard (out-of-area)
• Federal Employee Program (FEP)
• Medicare Advantage
• NASCO (shared administration)

We accept electronic claims for out-of-state Blue plans through the BlueCard Program. You can submit your BlueCard claims with your regular transmission files to us, using the same payer ID, and we'll coordinate with the member's home plan. Be sure to include the three-character plan prefix when submitting BlueCard claims. View BlueCard plan prefix list (login required). For more information, call our BlueCard team at 888-261-9562.

Premera also offers the following HIPAA transactions.

• 270/271—Health Care Eligibility Benefit Inquiry and Response
• 276/277—Health Care Claims Status Request and Response
• 835—Health Care Claim Payment/ Remittance Advice
• 837—Health Care Claim: Professional, Institutional, Dental
• 999—Functional Acknowledgements

Please contact us for details on exchanging specific transactions other than claims.

You can submit a corrected, replacement, or voided claim electronically using the HIPAA 837 standard claims transaction. Please include the following information:

• Frequency code of '7' in loop 2300, CLM05-3 segment to indicate a corrected/replacement of a previously processed claim. Use '8' to void a claim you billed in error.
• The initial Premera claim number (in loop 2300, REF01 must contain 'F8' and REF02 must contain the claim number).
• A free-form note (highly recommended) with an explanation for the corrected/replacement claim, in loop 2300 claim note as:
  • For professional and dental claims, segment NTE01 must contain 'ADD' and segment NTE02 must contain the note, for example: NTE*ADD*CORRECTED PROCEDURE CODE
  • For institutional claims, segment NTE01 must contain 'UPI' and segment NTE02 must contain the note, for example: NTE*UPI*CORRECTED LAB CHARGES

Secondary claims via EDI

When sending us a secondary claim, please include the following required information:

• Primary payer name
• Primary payer member ID for the patient
• Primary payer allowed amount
• Primary payer payment amount
• Primary payer reason for nonpayment (i.e., non-covered service, deductible, benefit maximum)
• Primary payer adjudication date for claim is required

If you have questions about billing these from your system, please contact your system vendor or clearinghouse.

Medicare note: When Premera is secondary to Medicare, there's no need to submit claims to Premera if your Medicare explanation of payment indicates the claim was forwarded (or crossed over) to the secondary payer. Submitting the claim to us will cause a duplicate.

Availity - Sign in to use secure tools.

BlueCard Program – Learn about electronic claims for out-of-state Blue plans.

Federal Employee Plan (FEP) – Use this website for FEP members in Washington and Alaska.

Electronic Funds Transfer (EFT) – Sign up for convenient, faster payments.

National Uniform Claim Committee (NUCC) – Learn about mapping from the 1500 claim form to 837.

National Uniform Billing Committee (NUBC) – Get additional institutional claim information.

OneHealthPort – View best practices for electronic transactions.

Email: EDI@premera.com
Fax: 425-918-4234 (for EDI enrollment forms only; no claims or PPI information)

Mailing Address:
To submit paper claims, correspondence, or medical records, please review the claims submission map.