Premera Blue Cross Prior Authorization
In Premera Blue Cross, you can’t submit the prior authorization request over the phone. You can submit the prior authorization request either through portal or Fax or through mailing address.
First and a very important step is to Check whether the service codes requires prior authorization or not and this can be done with the following link.
https://www.premera.com/ak/provider/code-check/
The above tools tell you whether the service requires review or not, please make sure to take a screenshot or copy of it for your records.
FEP-Federal Employee Program the member ID card which starts with letter “R” as separate Code list, below is the link for FEP prior approval List and forms and kindly fax these forms to 800-843-1114.(For more information on this please call at 877-342-5258, Option 3)
https://www.premera.com/fep/provider/prior-approval/
Now let us see how to obtain authorization if the service codes require authorization:
Portal:
2) If you find the service codes required prior authorization then the second step is to submit a request using prior authorization tool.
https://identity.onehealthport.com/EmpowerIDWebIdPForms/Login/PREMERA/
To Login One Health Port, you need a Subscriber ID.
If you don’t have subscriber ID register your organization with the following link
http://www.onehealthport.com/sso/register-your-organization
Technical issues contact Service Desk @800-722-9780
Or email support@premera.com
Once you login to the above portal, search the member with the member ID or Name or Date of Birth.
Next, enter the date when the services will be performed (This tool even verifies the member eligibility for the date entered), also select the place where the services will be performed and click on check procedure codes after entering your procedure codes.
Scroll to see your results, whether review is required or not for that particular services. In the same results even you will come to know why Premera Blue Cross wants to review and also documentation to submit with your request for prior authorization approval.
Once you come to know that you have codes that say review is required, then the next step is to click on “Next” to begin your review request.
Now you will under Additional Info Tab, where you will enter the Diagnosis code and add the name of the ordering provider (You can search either by Name or NPI).
If the requesting/ordering provider also the servicing provider, then check “Yes”
Then the next step is to select Hospital or facility and this is an optional.
Once you are finished, click “Next”.
Now you will be under Attachments Tab. Please click on Attach files, under File attachments and submit the requested documentation for that particular service codes.
And also make sure to add Phone and fax numbers under contact information section, so that Premera Blue Cross contacts you directly in case they have any questions.
Note:
Use Clinical Notes (Optional) field to provide more information about your request, such as additional diagnosis codes, number of units, Place of service for infusions, etc.
Finally, review your request before clicking on submit review request button. Because you won’t be able to make any changes or attach additional records unless Premera Blue cross ask for the more information.
Once you will submit the request you will be under Thank you page or Confirmation page which include reference ID number and also you will find the request as “Request Pending”.
No need to do anything if you have attached the requested documentation. If suppose you have missed or not attached the requested documentation, then you can fax the requested information or documentation through fax# 800-843-1114 (Make sure to include reference ID number).
In some cases, you may receive auto approval for service codes which doesn’t need documentation.
Now let us see how to request the prior authorization through Fax.
Fax:
You can also submit the request through fax to fax# 800-843-1114 by completing the below form along with supporting documentation (You can see the code list for more details).
Premera Blue Cross Prior authorization form:
https://www.premera.com/documents/014784.doc
Code List: https://www.premera.com/documents/027236.pdf
Provider outside of Washington and Alaska:
Login in to local Blue plans website for tools for out of area members and then you will be routed to Premera Blue cross prior authorization tool to submit a request.
Or you can fax the request with the same form which is available above.
Dental Providers:
Please submit with the following form
https://www.premera.com/documents/030000.doc
This can be either send through EDI or by mail to
Dental Review
PO Box 91059
Seattle, WA 98111-9159
How to Check Premera Blue Cross Prior Authorization Status:
You can check the status of Prior Authorization even if it was not submitted through portal.
Once you login the Portal, click on Check prior Authorization Status Tab.
You can search by member ID or reference ID number and review prior authorization status.
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