Forms

Preauthorization

You must receive approval for hospitalization or chemical dependency treatment before admission or no later than 48 hours following an emergency admission. For pre-authorization, please call 800-827-5058.

Where to send completed forms

Active and Non-Medicare Retirees

Medical and Vision Claims

• PPO Services Obtained in Oregon mail claims to: Regence BlueCross BlueShield of Oregon PO Box 30805 Salt Lake City, UT 84130-0805
• PPO Services Obtained in Washington & Alaska mail claims to: Premera Blue Cross PO Box 91080 Seattle, WA 98111-9180
• All Other Areas mail claims to: Local BlueCard Plan

Member Paid Claims, Dental Claims, and Time Loss Claims mail to:

• AGC IUOE Local 701 H&W PO Box 34687 Seattle, WA 98124-1687

Medicare Retirees

• Mail ALL claims to: AGC IUOE Local 701 H&W PO Box 34687 Seattle, WA 98124-1687

• All Other Completed Forms: Administration Office 15 82nd Drive, Suite 110 Gladstone, OR 97027