INSURER FILING GUIDE
Premera Blue Cross
Use this public information to prepare your packet, then confirm the route on the insurer's own page.
AT A GLANCE
Claim facts
| Member form | Claim Reimbursement Request Number: 008755 Revision: 01-16-2026 (printed in US order) Open the insurer form |
|---|---|
| Portal upload | YES |
| Portal path | Sign in at premera.com > Secure Inbox > attach the completed Claim Reimbursement Request and required documentation to a secure email |
| Mail address | Premera Blue Cross, PO Box 91059, Seattle, WA 98111-9159 |
| Fax | Not published by the insurer |
| Attachments | Patient name; diagnosis using ICD-10; service dates; procedure code using CPT, HCPCS, CDT, or NDC as applicable; provider name and address; provider IRS tax identification number; itemized charge for each service; proof of payment when applicable |
| Deadline | 365 days after date of service in the cited 2026 group contract |
| Outcome and status | Premera member account > Claims |
| Processing time | 30 days after receipt for post-service claims in the cited 2026 contract |
| Caveats | HMO or EPO ordinary out-of-network benefits may be absent; employer self-funded terms may differ; Medicare and Medicaid excluded |
STEP BY STEP
Filing steps
Source: https://www.premera.com/documents/008755.pdf
Read date: 10-09-2026
Research steps
- Download Claim Reimbursement Request 008755 (01-16-2026, printed in US order). Premera's mental-health page directs therapist claims to the member web portal or this form. https://www.premera.com/documents/008755.pdf and https://www.premera.com/visitor/care-essentials/mental-health
- Complete one form for one member and one provider. Multiple service dates from that provider may be included. Print and sign Section K. https://www.premera.com/documents/008755.pdf
- Attach the itemized bill with patient name, diagnosis code, service date, procedure code, provider name, address and tax ID, and charge for each service. Include proof of payment when applicable. https://www.premera.com/documents/008755.pdf
- Sign in at premera.com, select Secure Inbox, and attach the completed form and required documents to a secure email. https://www.premera.com/documents/008755.pdf
- Submit within 365 days after the service date under the cited 2026 group contract. Check Claims in the member account. The cited contract provides 30 days for a post-service claim decision. https://www.premera.com/documents/068796_2026.pdf
- NOT PUBLISHED: accepted file types, size, maximum files, exact packaging, submission confirmation, CMS-1500 treatment, typed or electronic-signature acceptance, or a guaranteed unassigned-benefit payee. https://www.premera.com/documents/008755.pdf
Filing facts
- Portal upload: YES
- Portal: Premera member account Secure Inbox
- Portal path: Sign in at premera.com > Secure Inbox > attach the completed Claim Reimbursement Request and required documentation to a secure email
- Mail address: Premera Blue Cross, PO Box 91059, Seattle, WA 98111-9159
- Fax: NOT PUBLISHED
- Attach: Patient name; diagnosis using ICD-10; service dates; procedure code using CPT, HCPCS, CDT, or NDC as applicable; provider name and address; provider IRS tax identification number; itemized charge for each service; proof of payment when applicable
- File types: NOT PUBLISHED
- File size limit: NOT PUBLISHED
- Maximum files: NOT PUBLISHED
- One file or separate files: Completed form and required documentation are attached to one secure message; whether separate files are required is NOT PUBLISHED
- Confirmation: NOT PUBLISHED
- Status check: Premera member account > Claims
- Processing time: 30 days after receipt for post-service claims in the cited 2026 contract
- Member deadline: 365 days after date of service in the cited 2026 group contract
- Deadline basis: YES: contract controls and some plans may specify a different period
- Mental health route: Premera's mental-health page specifically directs members with therapist claims to the member web portal or the same Claim Reimbursement Request
Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.
Read on 10-09-2026 from https://www.premera.com/documents/008755.pdf. Confirm the address, fax number or portal path on the insurer's own claims page before you send.