April 2, 2020
It’s important to know we have different delegation agreements in place with some of our provider groups for Medicare Advantage. Some groups are delegated for utilization management (UM) only, others are delegated for both UM and claims processing for our members. This means that some of our primary care providers perform UM and claim processing on behalf of Premera for their assigned Premera Medicare Advantage patients. In these instances, your practice may need to use different addresses, phone numbers, or EDI payer IDs to send UM requests and claims for processing.
To know which members are assigned to a delegated provider group, check the information on the back of the member’s ID card which includes:
- Primary care provider and the name of the clinic the member is assigned to
- Phone for the member’s medical authorizations
- Address for sending a member’s claims for payment, and who will process the claim
- EDI payer ID number to use
If you have questions about the updates, call Customer Service at 888-850-8526.