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  • Premera Member Submitted Claim Form

Get Premera Member Submitted Claim Form

P.O. Box 91059 Seattle, WA 98111-9159 Member Submitted Claim Form This form is to be used for medical and dental claims where you incurred expenses from a provider who did not bill the plan directly.

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Simply sign in to your account at claims.microsoft@premera.com Premera Blue Cross premera.com and select Secure Inbox. (from the Microsoft email alias only) PO Box 91059 Scan and send this completed form Seattle, WA 98111-9159 and any required documents back to us as a secure email attachment.

When you're looking up a claim using member information, make sure you click on the provider name to get details like the claim receipt date, pended reasons, and claim payment codes. We process most of our claims within 30 days and we pay claims every Saturday and on the last day of the month.

If you are unable to submit claims electronically, you can submit paper claims on CMS-1500 or UB-04 forms.

Contacting us General CorrespondenceHeadquarters Premera Blue Cross 7001 220th St SW Mountlake Terrace, WA 98043-2124Electronic Claims (EDI) EDI@premera.comEastern Washington 800-435-2715, option 2 Fax: 509-252-7794 PO Box 3048 Mail Stop 770 Spokane, WA 99220-3048Interest-related QuestionsPrompt Pay 800-932-28837 more rows

Timely Claims Submission Ideally, we'd like you to submit claims within 60 calendar days of the covered services, but no later than 365 calendar days. For most plans, we'll deny claims received more than 12 months after the date of service with no member responsibility.

You can reach Customer Service by calling 877-342-5258, option 2, or by calling the Customer Service phone number on the back of the member's ID card.

Claim payer IDs by category for Premera PlanProfessionalInstitutionalPremera Blue Cross*0043000430

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232