Premera Blue Cross Behavioral Health Billing in Washington: Availity, Associates and the New Provider Agreement
Premera Blue Cross behavioral health billing has a deadline coming: a new provider agreement takes effect for most Premera providers in November 2026. It changes how fast you must file claims and how you get fee schedules. Premera serves Washington state excluding Clark County, so this guide applies to the rest of the state. If your patient has a Regence BlueShield card, read our Washington Blue Cross guide instead.
What is the new Premera provider agreement?
Premera is replacing its Washington provider contract with a new agreement. Premera announced it on August 6, 2026. Most providers already in the network will see it take effect in November 2026, and new providers started receiving it from summer 2026 (Premera provider news, August 6, 2026). Premera’s FAQ says reimbursement rates and fee schedules are not changing, and that existing providers generally do not need to sign or return documents because this is a unilateral amendment and restatement (Premera provider agreement FAQ).
What changes in November 2026?
| Topic | What Premera’s FAQ says |
|---|---|
| Claim filing | Submit within 90 days, or 60 days for coordination of benefits |
| Overpayments | Refund within 30 days, after which Premera may offset |
| Fee schedules | Available only through Availity |
| Prior authorization | Requirements not changed, but electronic submission required |
| Rates | Not changing |
| Phase-in | Some provisions phase in after the effective date |
The FAQ also says providers cannot stay on the old agreement indefinitely, and it gives termination notice windows: 90 days before the new agreement takes effect, or 180 days after. The FAQ does not address behavioral health separately, so behavioral health providers should read their own contract. Premera’s provider relations team handles questions at with “PROVIDER AGREEMENT” in the subject. The new filing windows matter for every Premera Blue Cross behavioral health billing workflow.
How should I prepare?
- Read your contract and the FAQ before November.
- Check your claim workflow against the 90-day and 60-day windows. Our electronic claims submission page covers clean claims, and the claims processing glossary defines the terms.
- Register for Availity and test fee schedule access.
- Keep directory and credentialing information current, and send written notice of material changes through the Provider Update Form.
- Decide whether to stay in network. Our in-network versus out-of-network guide can help.
How do I handle Premera Blue Cross behavioral health billing day to day?
Availity Essentials is Premera’s primary secure provider portal. It handles eligibility, claim submission (free with Premera as payer), claim status and fee schedules. Prior authorizations through Availity are not supported for individual, Medicare Advantage, Federal Employee Program and some shared administration plans, and services reviewed by Carelon or eviCore must go through those vendors (Premera Availity FAQ).
Premera’s behavioral health page also covers telehealth and billing basics: it points to a telehealth payment policy and a claims submission guide, and warns that a provider who moves outside the Washington or Alaska service area loses in-network status even for telehealth (Premera behavioral health). Our telehealth modifiers 93 and 95 guide covers the coding side. Associate billing is a special case in Premera Blue Cross behavioral health billing.
What are Premera’s rules for associates and re-credentialing?
Premera does not credential associate-level providers, so they cannot hold a Premera contract. The associate must be billed as the rendering provider, and Premera says it accepts associate billing for up to 120 days if the license is in “pending” status, as of October 1, 2025. Re-credentialing occurs every three years, and late completion puts a contract at risk (same Premera behavioral health page).
Group owners should map every clinician’s license status. Our credentialing page explains the basics.
What do psychiatrists and psychotherapists check?
Psychotherapists should confirm time-based documentation for psychotherapy codes 90832, 90834 and 90837. Psychiatrists bill E/M visits with optional add-ons; check Premera’s payment policies in Availity for your codes. If a claim denies, our denied claims and appeals page shows next steps. Prepare early, because the new filing windows apply to Premera Blue Cross behavioral health billing from November.
Premera mistakes to avoid before November
- Waiting until your first late claim. Under the new terms, a claim filed after 90 days (or 60 for coordination of benefits) is outside the stated window.
- Assuming silence means no change. Premera says existing providers generally do not need to sign anything, but the new terms still apply.
- Hunting for fee schedules in old PDFs. Premera says fee schedules will be available only through Availity.
- Letting a clinician’s license status drift. Premera ties associate billing to license status, so review each clinician’s status regularly.
Tell your biller or office manager now. Put the 90-day filing rule on the front page of your claims workflow, and ask the billing team to flag any claim approaching 60 days old. Review overpayment handling too, since Premera says refunds are due within 30 days. If you use a billing service, ask that vendor to confirm its workflow matches the new windows before November. Putting these steps in place now keeps Premera Blue Cross behavioral health billing on schedule.
Frequently asked questions
Does the Premera agreement change my fees?
No. Premera says reimbursement rates and fee schedules are not changing.
How soon must I file Premera claims under the new agreement?
Within 90 days, or 60 days for coordination of benefits, according to Premera’s FAQ.
Does Premera cover Clark County?
No. Premera’s provider site says its Washington plans exclude Clark County.
Can an associate-level clinician hold a Premera contract?
No. Premera says it does not credential associate-level providers.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service, LLC works exclusively with mental and behavioral health practices, including psychotherapists and psychiatrists, and bills out-of-network claims. We offer our services to practices in Washington State, and we also work with practices in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. If you want to talk through your own billing, you can request a free consultation.
If you practice in Washington State, you can request a free consultation. Our Washington insurance contact guide and private insurance guides cover more.
