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

EDI@premera.com.

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)

or info@onehealthport.com.

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.