Use the Correct Form for Faster Appeal Response
We’ve recently noticed numerous appeals are being sent to the wrong Premera address or using the wrong form for the member’s plan. When submitting an appeal on behalf of a member, make sure to use the correct form to get the fastest response. You can choose from one of the following appeal forms that corresponds with the member’s plan:
Appeal Forms
Premera Blue Cross commercial plans
Federal Employee Program (FEP)
BlueCard – For out-of-area BlueCard members appealing through the member’s home Blue plan.
For individual and group plans from LifeWise Health Plan of Washington, you’ll find appeal forms on the LifeWise websites.
LifeWise group plans (Clark County)
Please take a moment to double-check any forms you may have bookmarked and make sure you’re sending us the right appeal form for the member’s plan.
Providers can submit an appeal for the following reasons:
- Clinical edit disagreements (include supporting documentation that shows correct billing)
- Medical necessity denials (provider write-offs)
- Allowed amounts that disagree with the contracted rate, multiple same-day reductions, denials for inclusive procedures, or OrthoNet denials
- Claims denied for timely filing
Please don’t submit appeals for:
- Billing errors
- Duplicate or eligibility denials
- Corrected claims
- Claims denied for needing medical records, incident questionnaires, or other additional processing information
- Coverage denials like coordination of benefits, worker’s comp, or subrogation
Appeal forms and more are located on our provider website Forms page. Be sure to bookmark our forms page for all the latest forms.