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www.premera.com

New tools for Provider Practices

Save time and reduce administrative expenses associated with patient collections.

The features and benefits of the Real-Time Estimate/Claims tool include:

  • Estimates patient share of cost for professional and dental services in real-time using most CPT, HCPCS, and ADA codes
  • Estimate response uses your contract allowance for the service and the patient's eligibility and benefit plan
  • Uses the patient's current deductible, coinsurance, copay, accumulators, and out of pocket maximum
  • Time-saving template option for your most common services
  • Ability to print a copy of the estimates for your patients about their share of cost at the time of service
  • Supports patient understanding about their cost for care and eliminates surprises
  • For paper claim submitters, option to submit claims in real-time (upon request)
To get started log in to the provider portal at www.premera.com and select 'Submit Estimate/Claim' from the left navigation menu. The tool will only display for contracted physicians, professional providers and dental providers.

Summary of services

  • Eligibility & Benefits - Get eligibility and benefit information for members, including deductible and benefit limit accumulators.
     
  • Claims - Check the status of your claims, quickly and easily.
     
  • BlueExchange - Access benefit, eligibility and your claim status details for nationwide BlueCard, NASCO and Federal Employee Program (FEP) members.
     
  • Claims Editor What If tool - Access the What If tool to test billing scenarios (for professional services only) and code combinations with our claims editing software and the tool shows specific coding rationale.
     
  • Prospective Review tool - Check procedure codes to determine if a benefit advisory is recommended or a prior authorization is required.
     
  • Advanced Imaging - Submit a request for review when ordering an advanced imaging service.
     
  • Submit Estimate/Claim*- Verify eligibility for benefits, estimate patient share of cost for professional and dental services or for paper claim submitters, option to submit claims in real-time (upon request).
     
  • Reference Materials - Access medical policies, payment policies, clinical practice guidelines, and forms.
     
  • Find a Doctor - Quickly find physicians and other providers in our networks.
     
  • Formulary Search - Get info on generic and brand-name drugs and find copay tier information and alternative drugs.
     

    * Only for contracted providers

Tutorials on how to use the Premera online tools:


Video tour - Eligibility and Benefits (Real Media Player - 3 minutes)

Video tour - Claims Status (Real Media Player - 3:34 minutes)

Video tour - Real-Time Estimates and Claims Module I (Real Media Player - 5:32 minutes)

Video tour - Real-time Estimates and Claims Module II (Real Media Player - 4:32 minutes)

Video tour - Claims Editor What If Tool (Real Media Player - 3:42 minutes)

 

 

An Independent Licensee of the Blue Cross Blue Shield Association

 




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