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Prior Authorization Form - Premera Blue Cross

Prior Authorization form Download, complete, and fax to 800-843-1114. Starting July 1, 2021, all handwritten, faxed forms will be returned without processing. Please check codes online to confirm if a review is required before submitting a Prior Authorization request. For the fastest response, sign in and use our secure online tools at for the following requests: Patient eligibility Prior Authorization code checks Prior Authorization Status checks, even if faxed Prior (for in-area providers only) A screenshot (with date) of the information found online can be used for verification documentation in case of appeal. For providers in Alaska: Get everything you need to know about Premera Prior Authorization at For providers outside of Alaska: Visit your local blue plan s provider website or Note: Unless specifically requested elsewhere in this document, do not send a DNA or other genetic sample, or the results of any genetic typing, test, or analysis, including DNA.

Prior Authorization Form Download, complete, and fax to 800-843-1114. Starting July 1, 2021, all handwritten, faxed forms will be returned without processing. Please check codes online to confirm if a review is required before submitting a prior authoriz ation request. For the fastest response, sign in and use our secure online tools at

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