BCBS AFFILIATEWA, AKPBM: Express Scripts

Premera Blue Cross (WA, AK) Prior Authorization Guide

Submit prior authorization requests and appeal denials with Premera Blue Cross. Phone numbers, fax numbers, appeal deadlines, step therapy override rights, and clinical documentation tips for WA, AK providers.

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Prior Authorization Contacts

PA PHONE

1-800-722-1471

PA FAX

1-425-918-5956

TURNAROUND

14 days standard, 72h expedited

TIMELY FILING

365 days

APPEALS MAILING ADDRESS

Premera Blue Cross, Attn: Member Appeals, PO Box 91059, Seattle, WA 98111

Common Denial Reasons

⚠ Premera Medical Policy criteria not met
⚠ Step therapy required
⚠ Non-preferred formulary
⚠ Site of care

Step Therapy Requirements & Override Rights

Premera serves Washington and Alaska. Washington RCW 48.43.420 (2019) provides step therapy override rights with 72-hour response requirement. Alaska has similar patient protection laws.

Tips for Premera Blue Cross Submissions

1. Premera covers both WA and AK
2. WA RCW 48.43.420 provides step therapy override rights
3. Washington has 365-day timely filing
4. Submit via Availity or Premera provider portal

External Review Authority

If Premera Blue Cross denies your final internal appeal, you have the right to request an external review through: Washington Office of the Insurance Commissioner / Alaska Division of Insurance.

External review decisions are binding on the insurer.