for physicians, providers
& office administrators
Online and IVR Features Guide
Fast and easy access to the information you needWith Premera Blue Cross it’s easy to get the information you need—when you need it. The provider portal at premera.com and our Interactive Voice Response (IVR) phone system offer 24/7 access to the information you require to serve patients, track claim status, check benefits, eligibility and much more.
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Provider HomeLog In / RegisterMy Premera
ToolsFind a DoctorRx SearchEligibility & BenefitsClaimsClaims EditorSubmit Estimate/Claim*
Utilization ReviewProspective ReviewAdvanced ImagingAdmission Notification
* For contracted providers
LibraryFormsReference InfoCommunicationsCare Facilitation Pharmacy
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My Premera•Readimportantinformation(Alerts!)
•Getthelatestprovidernews
•Accesssecurenewslettersandmanuals
•Bookmarkclaimsforeasytracking.
Tools Find a Doctor
•Quicklyfindphysiciansorotherprovidersin
ournetworks
•Createandprintcustomdirectories
Rx Search•Getinfoongenericandbrand-namedrugs
•Findcopaytierinformationand
alternative drugs
Eligibility & Benefits•Geteligibilityandbenefitinformationfor
members, including deductible and benefit
limit accumulators
•Accessbenefitandeligibilityinformationfor
nationwide BlueCard, NASCO and Federal
EmployeeProgram(FEP)members
Claims•CheckthestatusofyourclaimsforPremera
members,quicklyandeasily
•Accessclaimsstatusdetailsfornationwide
BlueCard, NASCO and Federal Employee
Program(FEP)members
•Claimseditingdetail.Viewclaimexplanationof
payment codes, including claims editing rationale
(whenavailable).
Our convenient online provider features reduce paperwork, save time, and make your job easier. Visit our secure provider portal—designed especially for physicians, dentists and other providers—today.
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A wealth of information at your fingertips
Using the provider portal is easy. To find out more, check out the “Getting Started” section of this guide.
Once you’ve followed the simple registration process, go to premera.com and log into the provider portal for instant access to these features:
Claims Editor•AccesstheWhatIfTooltotestbillingscenariosand
code combinations with our claims editing software —
and the tool shows specific coding rationale
Submit Estimate/Claim*
•Getpatientinformationabouttheirshareofcostat
the time of service
•Accuratecalculationusingyourcontractpricingand
patient eligibility, benefits, deductible, coinsurance,
copay,accumulators,andout-of-pocketmaximum
•Optiontoregisterforreal-timeclaimssubmission
Utilization Review Prospective Review
•Checkprocedurecodestodetermineifabenefit
advisory is recommended
Advanced Imaging•Submitarequestforreviewwhenorderingan
advanced imaging service
Admission Notification•Learnaboutouradmissionnotificationprocess
•Findthelistofservicesthatrequire
admission notification
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*Onlyforcontractedproviders.
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Library Forms
Download and print:
•ClaimsandBilling
•Caremanagementforms
•Credentialingforms
•Pharmacy
•SupportingDocumentationCoverSheet
•DocumentationandDiagnostic
Reference InformationViewreferencematerials,including:
•ClinicalPracticeGuidelines
•Medicalpolicies
•Paymentpolicies
•Referencemanuals
•EOPcodes
•Alphaplanprefixes
•Clinicalreviewbycodelist
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CommunicationsReview physician and provider newsletters for:
•Regulatoryupdates
•Newbusinessprocessesorchanges
•Clinicalanddiseasemanagementinformation
Care FacilitationLearn about our supportive programs and
services, including:
•CareManagement
•QualityPrograms
•DiseaseManagement
Pharmacy•PharmacyMailService
•DrugSearch
•ePocrates
•Point-of-SaleProgram
•GenericsProgram
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Provider HomeLog In / RegisterMy Premera
ToolsFind a DoctorRx SearchEligibility & BenefitsClaimsClaims EditorSubmit Estimate/Claim
Utilization ReviewProspective ReviewAdvanced ImagingAdmission Notification
LibraryFormsReference InfoCommunicationsCare Facilitation Pharmacy
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Log In Toaccesssecureinformationandservices—
• Clickonthe“LogIn”linkandthenenter: – Your User ID* – Your Password**
Premera Blue Cross has joined other leading healthcare organizations in standardizing the security of our web sites
through onehealthport.com. OneHealthPortoffersitssecurityservicesfreeofchargetoregisteredsubscribers.
Gettingstarted
* You will receive a User ID when you register at onehealthport.com.
** You create your own Password when you register at onehealthport.com.
* Registrationforfirst-timeusersonly.Onceyou’reregistered, youmayskipthisstep.
Go to premera.com ToaccesstheProvidersHomepage—
• Clickonthe“ForProviders”link.
Register*• Gotoonehealthport.com• Clickon“Register”andfollowtheinstructions at the site to register your organization and give designated employees access to premera.com.
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Information available quickly and efficiently Premera’sIVRphonesystemallowsyouto
eitherspeakyourresponsesorenter
themusingyourtelephonekeypad.
Withinminutes,youcansubmitand
obtain information for our members
without waiting on hold for a
customerservicerepresentative.
ZUse a headset with microphone or
handsetforcreatingrecords.Avoidusing aspeakerphone.
Keepyourtalkingenvironmentasquiet aspossible.
Before calling, have all the required information on-hand.
Speakintothephoneasclearlyaspossible.
Youmaychoosetokeyinnumbersforoptionsorcodes.
Enterthemember’sdateofbirthasmonth(usingtwodigits),day(usingtwodigits) andyear(usingfourdigits).Donotuseslashesorhyphens.
Example: 03011995 represents March 1, 1995
IfyoumakeanerrorwhilekeyinginthememberIDnumber,pressthe*keyandthesystemwillpromptyoutore-enterit.
Once familiar with the script, you no longer needtolistentothecompleteprompt.
If you request eligibility verification for more than one member at the same time, and you encounter subscriber or birth date errors, note them and wait until you have completed your inquiries before connecting to a customer servicerepresentative.
Bepatient!
Interactive Voice Response (IVR) Phone System
Customer Service IVR systemThefollowingoptionsareavailablethroughourCustomer
ServiceIVRphonesystembycalling877-342-5258, option 2.
• Retrieve member eligibility and benefit information
• Checkonclaimsstatus.
Care Management IVR systemThefollowingoptionsareavailablethroughourCare
ManagementIVRphonesystembycalling877-342-5258,
option 3.
• Physicians,homehealthagenciesandotherproviders
can enter requests for benefit advisories for inpatient/
outpatient procedures
• Providenotificationofhospitaladmission
• Checkbenefitadvisorystatus
• Enterspecificprocedurecodestodeterminewhena
benefitadvisoryisrecommended.
To complete a benefit advisory request, youwillneedthenumericprocedurecode(s),numeric
diagnosiscodeandthedateofservice(ifknown).
To provide notification of hospital admission request, you will
need to provide the date of admission and numeric
diagnosiscode.
To check the status of a benefit advisory, youwillneedtoprovidereferencenumber,ifknown,or
date request was submitted and numeric procedure
codessubmitted.
To determine when a benefit advisory is recommended, you will need to provide numeric
procedurecodes.
Tips for Successful IVR use:
BlueCard and NASCO member information is not available
through the IVR phone system.6
Save Time and Money Using Self-Service OptionsPremera offers online, voice-activation and self-service
optionssoyoucanquicklyobtainbenefits,eligibilityand
claimstatusinformation.
OuronlinetoolsandInteractiveVoiceResponse(IVR)phone
systemarequickandefficient.Theseself-serviceoptions
provide information even faster than direct calls to our
CustomerServicerepresentatives.
Online Options and ToolsUsingPremera’ssecureproviderportalcansavesignificant
timecomparedwithphoneinquiries.Simplyregisterat
onehealthport.comforafreeIDandpassword.
Youcanquicklyobtainclaimsinformationonoursecureweb
site at premera.com/provider.Logon24hoursaday,7days
aweektousethefollowingoptions:
• EligibilityandBenefits
• ClaimStatus
• BlueExchange(forBlueCard,NASCO,andFEPmembers)
• ClaimsEditor/WhatIfTool:Testbillingscenarioswithour
claimseditingsoftware.
OneHealthPort’s Training CenterTolearnmoreaboutnavigationandfunctionalityofour
onlinetools,watchourvideotoursatonehealthport.com.
WehavealinktoOneHealthPort’sTrainingCenterfromour
landing page at premera.com/provider.Itislocatedunder
ResourcesandTools.
IVR Phone SystemPremera’sIVRphonesystemisanotherefficientresourceyou
can use to obtain eligibility, benefits and claim status.*
ToaccessourIVRphonesystem,call:
• CustomerService:
877-342-5258,option2
• CareManagement:
877-342-5258, option 3
• FEP(FederalEmployeeProgram):
800-562-1011
* BlueCard and NASCO member information is not available through the IVR system.
More Time-Saving TipsElectronic Billing Providerswhosubmitclaimselectronicallycanalsotake
advantage of other electronic transactions – for example,
checkingeligibilityordoingaclaimsstatusinquiry.
If you are currently billing on paper, billing electronically will
improvetheturnaroundtimeofyourpayments.(Youcan
alsosubmitcorrectedclaimselectronically.)
• Electronicsubmission:7-15days
• Typedstandardclaimform:15-21days
• Handwrittenstandardclaimform:21+days
TogetstartedcontactEDIat800-435-2715oremail
Claim Status Inquiries Didyouknowweprocess98percentofclaimswithin30days
ofreceipt?Toincreaseefficiencyandminimizephonecalls
and administrative costs for your office:
• Submitclaimsassoonaspossible
• Checktheproviderportalforclaimstatusbeforecalling
Customer Service
• Waituntiltheclaimisinprocessatleast30daysbefore
callingus.
Questions?If you have questions or comments about our self-service
options, please call Premera Physician and Provider Relations
at 877-342-5258, option 4.
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Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association
012428(01-2011)
OneHealthPort Registration For information on how to register, go to
onehealthport.com.Questions?
Contact OneHealthPort at 800-973-4797(tollfree)
OneHealthPort Technical Support TechnicalsupportforOneHealthPortisprovidedby
PlanITTechnologyGroup,OneHealthPort’s
technologypartner.
Self-help and test your login are available at:
onehealthport.com/use_ohp/support.php or by calling
800-973-4797(tollfree).
Customer ServiceIf you have specific questions about a claim, member
eligibility or member benefits, please contact Premera
Customer Service: 877-342-5258, option 2.
Important Phone Numbers
Provider RelationsIfyouhavequestionsaboutnetworkparticipationor
contracting, please contact the Premera Physician and
Provider RelationsTeam:877-342-5258, option 4.
Technical ProblemsIfyou’reexperiencingtechnicaldifficultieswith
oursite,pleasecontactthePremeraWebSupport
Team:877-342-5258, option 5.
Recommended Web browsers and screen resolution
ThissiteisbestviewedusingaWindows-basedcomputer
systemandeitherInternetExplorer5.5orhigheror
Firefox/Mozilla1.5orhigher.