Individual Plan Tools and Resources

  • Secure provider individual plan website

    The secure individual plan website is managed by Evolent Health for Premera and uses tools specifically for patients with individual plans.

    Sign in now

    Note: Google Chrome is the best browser to use for the individual plan website.

    Sign in to the secure site to access the following tools:

    • Eligibility and benefits
    • Claims
    • Utilization review and prior authorization
    • PCP roster

    Secure website access: When you sign in, you might see the message, "You have successfully logged into the Evolent application, but we do not find the provider." This happens because Evolent uses Identifi for prior authorizations. Identifi needs 1 to 5 days to set up your secure access. During that timeframe, you can use the information below to check eligibility, submit prior authorization, claims, and appeals for your individual plan patients.

  • Learn about our programs that help members navigate the healthcare system and manage their health.

    Get claim status, detailed payment information, and explanation of payments (EOPs) on the secure individual plan website.

    CMS 1500 online claims submission: The online claims submission tool for HCFA (CMS) 1500 claims currently isn’t available on the individual secure website. In the meantime, submit paper claims, appeals, and other paper correspondence by mail to:

    Premera Blue Cross
    PO Box 21702
    Eagan, MN 55121

    Professional and institutional claims: The claim payer ID is 00430 and for dental claims the ID is 47570.

    Customer service: Call customer service at 800-607-0546 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. Customer service can also provide web support and information on member eligibility and benefits.

    Care management: Call care management at 844-996-0329 or fax 888-302-9325.

    InstaMed delivers all EFT payments and ERA for individual plans. If you submit and receive EFT/ERA through a clearing house, the clearing house needs to sign up for InstaMed. This process is not completed by Premera EDI. Providers should be enrolled with InstaMed and Premera EDI to ensure they receive all Premera electronic remittance reports.

    It is important that providers sign in to InstaMed to confirm their billing national provider identifier (NPI2) numbers are accurate, current, and match the correct taxpayer identification number (TIN).

    Online instead of paper EOPs: EFT enrollment automatically turns off your paper explanation of payments (EOPs) for all Premera business entities and affiliates. After you enroll, you’ll only have online access to your EOPs.

    Already have InstaMed?

    Great! You’ll automatically receive EFT payments for our individual plan claims.

    New to InstaMed?

    You have 2 simple ways to sign up:

    Individual plan forms:

    Visit our forms page for all other provider documents.

    If a member has an individual plan, their ID card will say Individual Plan. View a sample member ID card.

    View prefix list for Individual Plans.

    The secure member eligibility search doesn’t accept member prefixes. Search by member ID or by the member’s last name and date of birth for accurate results.

    Review our individual plan policies on our policy page.

    Individual plans have a specific code list and InterQual criteria when reviewing certain services.

    A form isn't needed for sending us refund (overpayment) checks to Premera. You can submit requests in writing and include the following related to the overpayment:

    • Member first and last name and ID number
    • Date of service
    • Amount and reason for refund
    • Primary explanation of payment (if related to coordination of benefits)
      Mail provider refund checks to:
      Premera Provider Refunds
      P.O. Box 840571
      Los Angeles CA 90084-0571

    You can submit a prior authorization for Premera Individual plan members using the Identifi online submission tool or you can fax the prior authorization form. View code list.

    Access Identifi to submit a prior authorization request. Important: To prevent delays, check the prior authorization code list before submitting a request to see if review is required or should be submitted through Carelon. Care notes, phone numbers, and fax numbers are required fields on the Identifi prior authorization tool.

    Once you log in, it takes 1-5 business days to process your access to Identifi. If you need to submit a prior authorization during the waiting period, which automatically starts once you've clicked on the link to the Individual Plan secure provider portal, you can fax your submission or call our utilization management team. You can also call the customer service number on the back of the member ID card. You'll receive a confirmation email once you have Identifi access.

    To contact our utilization management team, call 844-996-0329 or fax 888-302-9325. Use this fax number to submit a prior authorization request.

    Search for medical providers, facilities, and other specialists within the Premera Blue Cross Individual Signature network.

    Complete and email a provider update form if you have any office changes.

    Visit the Update Provider Information page to learn about verifying your provider directory information with BetterDoctor, access our provider update form, and more.