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)

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