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01. Edit your premera prior authorization form online
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03. Share your form with others
Send premera prior authorization via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out premera forms with our platform
- Click ‘Get Form’ to open the Premera form in the editor.
- Begin by entering your Practitioner Name in the designated fields for Last Name, First Name, and Middle Initial.
- Fill in your Social Security Number and Date of Birth, selecting your gender by checking the appropriate box.
- Provide your State License Number and specify the state. If applicable, include any additional state licenses.
- Complete the sections for UPIN, DEA, Medicare numbers, and Individual NPI as required.
- Indicate any foreign languages spoken and list your specialties along with their board status.
- Enter your clinic/group name, Group NPI, start date at the clinic/group, and primary practice address.
- Specify available services such as wheelchair accessibility and interpretive services. Fill in office hours and contact information.
- If you have multiple practice locations, attach a list with the same information for each location.
- Finally, sign off on the form by entering your name and date completed.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2005 | 4.8 Satisfied (163 Votes) |
Got questions?
We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
Are Premera and Blue Cross Blue Shield the same?
Premera Blue Cross is a not-for-profit Blue Cross Blue Shield licensed healthcare company that offers health plans in Washington state and Alaska.
What association is Premera part of?
And, as part of the Blue Cross Blue Shield Association, Premera members have access to the largest nationwide network of any other major health plan.
How do I contact Premera?
(800) 722-1471 Premera Blue Cross / Customer service
Who owns Premera?
Blue Cross Blue Shield Association Premera Blue Cross / Parent organization
What is Blue Cross Blue Shield called in Washington?
About Premera Blue Cross Premera is headquartered in Washington State and provides health benefits to 2.8 million people nationwide. Our SEBB plans are designed with school employees in mind and are backed by best-in-class customer service and the Blue Cross Blue Shield Association.
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People also ask
Is Premera leaving Washington state?
Even though we will no longer offer Medicare Advantage plans in 2025, Premera isnt leaving the senior market entirely. Well continue to offer Medicare Supplement plans, serving more than 58,000 members in Washington and Alaska.
