Premera Blue Cross Behavioral Health Billing: 5 Easy Steps
Premera Blue Cross behavioral health billing in Washington is changing this fall because Premera is replacing its provider contract. Premera announced the new agreement on August 6, 2026, and it starts for most existing network providers in November 2026. This guide shows what changes, who is affected and what to check now.
What changed in Premera Blue Cross behavioral health billing?
Premera is moving providers to a new agreement. Its provider agreement FAQ says the agreement does not change existing reimbursement or rates. It does change several business rules that affect every claim.
| Item | What the Premera FAQ says |
|---|---|
| Claim filing | Within 90 days |
| Coordination of benefits (COB) claims | Within 60 days |
| Overpayments | Refund within 30 days, after which Premera may offset |
| Fee schedules | Available through Availity, not from Provider Relations |
| Termination notice | 90 days’ written notice before the agreement takes effect, 180 days after |
When it takes effect
For existing network providers, the agreement starts 90 days after Premera gives notice, which Premera says is November 2026 for most. New providers have been receiving it since late July 2026. Premera’s August 6 news item adds that some operational provisions will phase in over several months, and that Premera intends to enforce them once they are operational.
Who it affects
Most existing in-network providers and all new providers are affected. Existing contracted providers do not need to sign or return anything, because Premera is using a unilateral amendment and restatement process. New providers and those on custom contracts must sign, and custom contracts follow their own termination terms. Washington is not one of MCM South’s ten served states, so treat this as a payer guide for any practice that bills Premera.
Check your own Premera Blue Cross behavioral health billing against your contract, because custom contracts can differ.
Practical impact on Premera Blue Cross behavioral health billing
The biggest daily change is the filing window. If your billing runs weekly, a 90-day window leaves little room for rework, and a 60-day COB window leaves less. Check your clean claim rate and your aging report, because older claims are the ones that now carry risk.
Private payers
Premera’s Availity FAQ says providers can submit professional claims in Availity at no cost when Premera is the payer, check eligibility and claim status, and view remittances. Prior authorization works differently. Availity does not fully support individual plans, Federal Employee Program members or some shared administration plans, and some services go to Carelon or eviCore. Premera does not accept retroactive prior authorizations.
Associates and re-credentialing
Premera’s behavioral health page says it does not credential associate-level providers. Since October 1, 2025, it accepts associate billing for up to 120 days while the license is “pending.” Network status depends on the billing provider’s tax ID. Re-credentialing happens every three years, and missing it puts your contract at risk. Providers who move out of Washington or Alaska lose in-network status, even for telehealth.
Medicare and Medicaid
The Availity FAQ says Premera’s Medicare Advantage plans ended on January 1, 2025. This post does not cover Medicaid or Medicare. Check CMS and the state Medicaid agency for those programs.
State rules
This post does not cover Washington insurance regulations. Ask the Washington insurance commissioner or your counsel for state rules, and read our Washington Blue Cross guide for plan details.
What do psychotherapists and psychiatrists check?
Time-based psychotherapy codes such as 90832, 90834 and 90837 need minutes in the note, so confirm your templates record them. See our guide to individual psychotherapy codes. Psychiatrists should ask Premera how evaluation and management (E/M) visits and psychotherapy add-on codes are handled under the new agreement. For telehealth, check our guide to modifiers 93 and 95 and Premera’s telehealth guide.
What to do next
These steps keep your Premera Blue Cross behavioral health billing on schedule.
- Find your Premera contract and confirm whether you are on the standard agreement or a custom contract.
- Set a billing rule that sends every Premera claim well inside 90 days, and COB claims inside 60.
- Register your team for Availity if you have not, and download your fee schedules.
- Check your re-credentialing date and your associate billing plan. See in-network and out-of-network credentialing for the bigger picture.
- Save our Washington insurance contact guide for the right department.
Questions to verify with Premera
Ask Premera these questions about your Premera Blue Cross behavioral health billing before November.
- What is my exact effective date, and does my contract have custom terms?
- Do the 90-day and 60-day windows apply to corrected claims?
- Which of my services need Carelon or eviCore review?
- How do I submit written questions? Premera’s FAQ says to email Provider Relations with “PROVIDER AGREEMENT” in the subject line and include your tax ID.
The short version: Premera Blue Cross behavioral health billing
Premera Blue Cross behavioral health billing is moving to a new agreement in November 2026 with a 90-day filing window, a 60-day COB window and a 30-day overpayment refund rule. Rates are not changing, according to Premera. Check your effective date, use Availity and keep your credentialing current.
How MCM South helps
MCM South Medical Billing Service, LLC bills exclusively for mental and behavioral health. We work with psychotherapists and psychiatrists in solo and medium-size practices, and we bill out-of-network claims for clients. For follow-up on late or denied claims, see our service for denied and rejected claims.
Keep going
Related reading
Want help with payer follow-up? Talk to us.
FAQ
Is Premera changing its reimbursement rates?
Premera’s provider agreement FAQ says the agreement does not change existing reimbursement or rates. Fee schedules are available through Availity.
How long do I have to file a Premera claim under the new agreement?
The FAQ says 90 days, or 60 days for coordination of benefits claims. Check whether your contract has custom terms.
Does Premera credential associate-level clinicians?
No. Premera’s behavioral health page says it does not credential associate-level providers. Since October 1, 2025, it accepts associate billing for up to 120 days while a license is pending.
Does this guide mean MCM South serves Washington?
No. Washington is not among MCM South’s ten served states. This is a payer guide for any practice that bills Premera.
Where MCM South works
MCM South Medical Billing Service, LLC is available to provide billing services to psychotherapists and psychiatrists in Washington, and in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.
This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.
