Premera Blue Cross Vendor Onboarding Guide Last Updated: October 24, 2018
023082 (10-24-2018) Table of Contents Section 1: Introduction………………………………………………………….……… 3 Welcome Letter……………………………………………………………………………………... 3 Objectives……………………………………………………………………………………………….. 3 Section 2: Company Background………………………………………….……… 3 2.1 Blue Cross/Blue Shield History…………….……………………..……….... 3 2.2 Premera History…..……………………………………………………………..….... 3 2.3 Affiliate Description………………………………………………………….………. 6 Section 3: Premera Corporate Objectives……………………………………. 7 3.1 Mission, Vision, Goal…………………………………………………………….….. 7 3.2 Core Values………………………………………………………………………….……. 8 Section 4: Locations……………………………………………………………………… 8 4.1 Mountlake Terrace, WA……………………………………………………………. 8 4.2 Spokane, WA……………………………………………………………………………... 8 4.3 Anchorage, AK…………………………………………………………………………... 9 Section 5: Requirements……………………………………………………………... 10 5.1 HIPAA…………………………………………………………………………………..…….. 10 5.2 Insurance……………………………………………………………………………………. 10 5.3 Service Operations Control Audits…...………………………………….... 10 5.4 CVENT…………………………………………………………………………………………. 11 5.5 Annual Attestations/Questionnaires……………………………………….11 Section 6: Vendor Management………………………………………………..…. 12 6.1 Organization……………………………………………………………………….……... 12 6.2 Vendor Performance…………………………………………………………..……. 12 Section 7: Contracting Process………………………………………………..….. 13 7.1 Contracting Process Flow Chart…………………………………………….. 13 Section 8: Forms...…………………………..………………..…………………………. 13 8.1 Vendor Add…………………………………………………………………………….….. 13 8.2 W9…………………………………………………………………………………………….…. 13 023082 (10-24-2018)
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8.3 W8ECI Foreign…………………………………………………………………………... 13 8.4 Electronic Funding Authorization……………………………………………. 14 Section 9: Invoicing and Receiving Requirements…..………………….. 14 9.1 Invoicing Requirements……………………………………………………………. 14 9.2 Receiving Requirements…...………………………………………………..…… 14 Section 10: Policies………………………………………………………………….…… 14 10.1 Gift………………………………………………………………………………………………. 14 10.2 Travel…………………………………………………………………………………………… 15 Section 11: FAQs…………………………………………………………………….……. 15 11.1 FAQ Document…………………………………………………………………..……... 15 Section 12: Contacts…………………………………………………………………….. 17 12.1 Premera Contacts…………………………………………………………………….. 17
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Section 1: Introduction
1.1 Welcome Letter
Whether you are a new or returning vendor to Premera, this resource guide will help us work together more efficiently and effectively. We have put together this guide so that our vendors will know what we need and expect from our relationship.
As a longtime Northwest company, we value a strong work ethic, teamwork, and realistic expectations. We appreciate loyalty and integrity. With more than 2.2 million members, our customers come first. You play an important role in our mission to provide peace of mind to our customers about their healthcare coverage by providing timely, quality goods and services at competitive rates.
Because we honor our commitments and recognize the importance of our working relationships, we strive to work with vendors who share these values. This guide will answer your questions and give you other helpful information about doing business with Premera.
1.2 Objectives
The purpose of this handbook is to provide details on Premera and Premera’s requirements for vendors. The principal objectives of this Vendor Onboarding Guide are:
• To provide working knowledge of Premera as a company
• To provide the necessary information for vendors to comply with Premera requirements
As we enhance how we purchase our products and services and make this available to our customers, the Vendor Onboarding Guide will be updated and refined periodically to reflect the most current information.
Section 2: Company Background
2.1 Blue Cross/Blue Shield History
The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross® and Blue Shield® companies. The association owns and manages the Blue Cross and Blue Shield trademarks and names in more than 170 countries and territories worldwide. The association grants licenses to independent companies to use the trademarks and names in exclusive geographic areas.
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The association also operates several business initiatives in support of the Blue Cross and Blue Shield companies and represents the Blue System in national forums. In this role as a national association, BCBSA is responsible for advancing Blue Cross and Blue Shield interests in legislative and regulatory initiatives in Washington, D.C. It is also responsible for coordinating legislative, regulatory, and political strategy for the Blue system.
Blue Cross and Blue Shield Companies
Operating and offering healthcare coverage in all 50 states, the District of Columbia, and Puerto Rico, the 36 Blue Cross and Blue Shield companies cover more than 107 million members. Nationwide, more than 96% of hospitals and 92% of professional providers contract with Blue Cross and Blue Shield companies—more than any other health plan provider.
Blue Cross and Blue Shield companies offer a variety of health plan products to all segments of the population, including large employer groups, small business, and individuals. The Blues® currently serve 85% of Fortune 100 companies and 76% of Fortune 500 companies. Moreover, the Blues have enrolled more than half of all U.S. federal workers, retirees, and their families. This makes the Federal Employee Program the largest single health plan group in the world.
2.2 Premera History
The Premera Blue Cross Story - Blue Cross Plan Is Born in Dallas
• The nationwide Blue Cross organization can be traced to a hospital prepayment plan for school teachers. Justin Ford Kimball started the plan in 1929 for the Baylor University Hospital in Dallas. For a prepayment of 50 cents a month, the plan provided 21 days of hospitalization in a semi-private room.
• Plans began forming across the country; each was associated with a single hospital. By 1932, community-wide plans emerged, offering subscribers a choice of hospitals. In 1933, the American Hospital Association began to encourage the development of such plans and began to regulate and approve them. The same year, the plan in St. Paul, Minnesota, began using a blue cross. The symbol of the blue cross was officially adopted by the American Hospital Association in 1939.
• On June 30, 1972, ownership of the Blue Cross symbol and name passed to the Blue Cross Association. On Feb. 27, 1973, a new symbol was introduced: a blue Greek cross with a stylized human figure in its center.
Blue Shield Plan is Born
• In 1900, the Blue Shield concept emerged from the lumber and mining camps of the Pacific Northwest at the turn of the century. Employers wanted to provide medical care for their workers. To do this, they paid monthly fees to "medical service bureaus" composed of groups of physicians.
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• In 1939, these pioneer programs lead to the first Blue Shield Plan, which was established in California in 1939.
Blue Cross comes to Pacific Northwest in 1945
• After World War II, business boomed with healthy, happy working people anxious to ensure the health of their families.
• Our company was incorporated as a healthcare service contractor on May 5, 1945, when it was known as Washington Hospital Service. On July 8, 1948, the original certificate of registration was issued by the State Insurance Commissioner. It authorized the acceptance of prepayment for healthcare benefits.
• Our Alaska plan has a proud history of service and support in Alaska since 1952.
• On March 14, 1969, we changed our name to Blue Cross of Washington and Alaska.
MSC Becomes a New Partner in 1994
• In 1994, Blue Cross of Washington and Alaska affiliated with Medical Service Corporation (MSC) in Spokane, the Blue Shield plan serving Eastern Washington. This partnership was formed to strengthen our companies while still offering local service to the communities where we work and live.
• MSC’s roots go back to November 1933, when the nonprofit Spokane Medical Service Bureau and the Medical Service Corporation were founded, enabling people to afford quality healthcare.
• The original coverage offered was limited to groups of 25 or more, each earning less than $150 per month. The premium was $1 per month and included doctor and hospital services and prescription drug benefits. Keep in mind that in 1933, doctor visits were $2, hospital charges ran $2.75 per day, and a tonsillectomy might have cost $12.50.
Name Changes to Premera Blue Cross after 1998 Merger
• In June 1998, Blue Cross of Washington and Alaska merged with Medical Service Corporation (MSC) and changed its name to Premera Blue Cross. In Eastern Washington, the company known as MSC incorporated as Premera Blue Cross.
• In June 2002, Premera introduced an evolutionary new approach to health plans called Dimensions. Encompassing a new business model, a new portfolio of consumer-friendly products, simplified operations, and fresh technology was created. Dimensions re-ignited a spirit of collaboration between our company and providers. This helped doctors reduce variations from best practices that added costs without improving care. It also simplified
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administration, cut down paperwork, enhanced excellent service, and ultimately empowered consumers to make informed, responsible choices about their healthcare.
• Also in June 2002, MSC incorporated as Premera Blue Cross. It was renamed Premera Blue Cross to better emphasize our statewide presence in Washington. It also reduced confusion among members, physicians, and other providers. Blue Cross Blue Shield of Alaska was renamed Premera Blue Cross Blue Shield of Alaska to emphasize the plan’s connection with the Premera family of health plans.
Position for the Future
• In 2009, Premera launched Vivacity, a subsidiary created to consult with large employers on health and wellness programs for their employees. The Vivacity launch opened up new avenues to influence member behavior—essential to managing healthcare costs. In 2011, Premera launched a new employer benefit plan design that packaged Vivacity wellness activities with employers’ existing plans. This incented employees to engage in wellness activities with the opportunity to earn richer benefits and lower premiums or cost sharing.
• In 2013, Premera offered plans through the new Healthcare Exchange and came out the clear leader in Washington, with approximately 60% of enrolled plans through LifeWise or Premera branded plans.
• In 2014, Premera entered the Medicare Advantage market with plans that were created to appeal to a variety of consumer segments. Plan options offered a range of affordable price points and benefit designs to meet the unique budget and healthcare needs of Medicare- eligible individuals.
2.3 Affiliate Description
You know us as Premera Blue Cross, or in Alaska, Premera Blue Cross Blue Shield of Alaska.
Premera also includes subsidiary companies that are not affiliated with Blue Cross or Blue Shield, but which provide a wide variety of choices. These companies provide everything from group life and disability to third-party administration for self-funded employers. They have operations in Mountlake Terrace and Spokane, Washington; Anchorage, Alaska; and Portland, Oregon.
LifeWise Health Plan of Washington Healthcare coverage for individuals and families in Washington www.lifewisewa.com
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LifeWise Assurance Company Provides Medical Stop Loss coverage in 16 Western states. Highly integrated medical Stop Loss solutions are available for self-funded plans administered by Premera or its affiliates. Stand-alone Medical Stop Loss programs are also available for self-funded plans using other third party administrators and carriers. www.lifewiseac.com
Connexion Insurance Solutions Headquartered near Seattle, Washington, the company supports the needs of insurance producers and agencies focused on the small group and individual markets. We connect our over 1,200 affiliated insurance producers with carriers, products, training, quotes, and administrative support so that they can focus on their clients. www.connexioninsurance.com
Vivacity Provides innovative wellness services and products to employers seeking to achieve a healthier workforce. www.vivacity.net
Section 3: Premera Corporate Objectives
3.1 Purpose, Values, Customer Statement
Premera provides a purpose, values, and customer statement to guide its employees in our work. Premera expects its vendors to understand these and help Premera to achieve them.
• Purpose: Improve customers’ lives by making healthcare work better.
• Values: The customer is at the center of all we do. Identify with the customer, act with urgency, be excellent, challenge convention, do the right thing, and work together.
• Customer Statement: What our customers will say about us. “You take great care of me and make it simple and easy.”
In addition, vendor management at Premera has a mission and vision to help in fulfilling Premera’s corporate objectives.
• Mission: We contribute to the success of Premera by promoting vendor disciplines, including strategic engagement, performance, and management.
• Vision: We are trusted to optimize vendor value for our customers.
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3.2 Core Values
Premera embraces a set of values that guides the company toward its goals. Premera expects its Vendors to embrace these values as well.
• Identify with the Customer
• Act with Urgency
• Be Excellent
• Challenge Convention
• Do the Right Thing
• Work Together
Section 4: Premera Locations
4.1 Mountlake Terrace, WA
Premera’s Mountlake Terrace campus serves as the company’s headquarters. Home to five buildings, the campus provides over 500,000 square feet of employee workspace and serves a good portion of Premera’s 3,400 employees.
7701 220th St. SW Mountlake Terrace, WA 98043
4.2 Spokane, WA
The Spokane campus is Premera’s second-largest campus. The campus features three buildings and 200,000 square feet of workspace.
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3900 E. Sprague Spokane, WA 99202
4.3 Anchorage, AK
Premera’s Alaska office is located in Anchorage.
3800 Centerpoint Drive Suite 940 Anchorage, AK 99503
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Section 5: Premera Requirements
5.1 HIPAA
For Vendors identified as a business associate, federal law requires the Vendor and Premera enter into a business associate agreement (BAA). The vendor is the health plan’s business associate as described in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and agrees to abide by the Business Associate Terms and Conditions set forth in the Agreement.
5.2 Insurance
Vendors shall carry such policies of general liability, errors and omissions, workers compensation, cyber insurance, and other such usual and customary insurance coverages in amounts as may be necessary to insure itself against claims, liability, or damages arising out of or connected to the performance of its obligations under the Agreement. Upon execution of the Agreement, Vendor is required to provide Premera with certificates evidencing such insurance and to immediately notify Premera in the event any such insurance coverages are cancelled or materially change during the course of the Agreement.
5.3 Service Operations Control Audits (SOC)
For Vendors that store Premrea Confidential information or have access to systems, on an annual basis, Vendor, at its sole expense, shall have an independent auditor conduct an audit of the
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following Vendor’s internal controls and prepare a Service Operations Control Type 2 (SOC2), or equivalent, report that will include the five trust principles of security, availability, processing integrity, confidentiality, and privacy. Vendor will provide the SOC2 audit report to Premera within thirty (30) days after its completion on an annual basis.
5.4 Non-Employee Training and Attestation (CVENT)
Consultants, Vendor, and Temporary Workers (Non-Employees) that will have access to Premera’s network or buildings are required to complete online privacy and confidentiality training (via CVENT). Each individual that will have such access must complete this training, and the following information is required at a minimum:
Name – Exactly as provided on the individual’s official identification card
Email address – Unique and specific to the individual taking the training
The CVENT training includes Code of Conduct, Privacy, Physical Security of Premise, Guidelines for Handling and Distributing Proprietary Information, and Parking Procedures. Individuals should print and bring a Proof of Completion in advance of arriving on Premera campus or requesting system access.
Note: If this training is not completed prior to the start date, the individual will not be granted system access or a badge and may experience a delay that will be at the vendor’s cost and their responsibility to address.
CVENT Training link is located here: REQUIRED: Non-Employee Onboarding Training for Premera
5.5 Annual Attestations/Questionnaires
For Vendors that store Premrea Confidential information or have access to systems, on an annual basis, Vendors are required to complete attestations and questionnaires sent by Premera in a timely manner. These attestations and questionnaires may include such things as Security, Business Associate (BA), Qualified Health Plans (QHP), and Medicare Advantage (MA).
5.6 HITRUST
As part of Premera’s HITRUST certification, Vendors may be required to comply with requirements for Third Party Assurances related to Premera’s certification. This may include background checks with artifacts, notice of Vendor personnel termination, encrytption requirements, and other applicable control objectives.
5.7 Trademarks / Service Marks / Public Announcements
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Vendor may not use Premera’s names, symbols, trademarks or service marks in any form of advertising, promotional materials, or social media without Premera’s prior written consent. Vendor may not make any public announcements about its relationship with Premera without Premera’s prior written consent.
Section 6: Vendor Management
6.1 Organization
Each of Premera’s business units is supported by Vendor Management, which enables consistent, high-level service delivery of program standardization while effectively leveraging subject matter experts and best practices. Vendor Management is partnered with the contracting team and work in conjunction with Shared Services, comprised of Finance, Compliance, Ethics & Internal Audit, Legal, Business Continuity, and IT Security.
6.2 Vendor Performance
How We Review and Report Vendor Performance
Scorecards
We use a scorecard to monitor Vendor performance against stated objectives. The Vendor scorecard provides timely feedback on quality, delivery, service levels, and metrics defined in supplier contracts. Vendors performing below stated expectations will be required to either participate in onsite formal performance reviews or submit root cause and corrective actions to address performance. Our objective is to provide our Vendors with the tools, information, and resources needed to improve their performance.
Quarterly Business Reviews
In addition to the scorecard, we also use monthly, quarterly, or annual business reviews with Vendors to evaluate the success of our Vendor relationships. The quarterly business reviews are often focused on forward-looking Vendor development and includes elements such as performance, collaboration, business health, and other pertinent topics.
Service Level Agreements & Performance Guarantees
Service Level Agreements and Performance Guarantees are also included in Vendor relationships to ensure performance is measured against meaningful standards. Vendors are expected to monitor these metrics and report to Premera in accordance with the Agreement to show the
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value of the relationship is maintained over time and that Premera’s customers are receiving the best services and product available.
Section 7: Contracting Process
7.1 Process Flowchart
Section 8: Premera Forms
8.1 Vendor Add
This form is completed by the Vendor and provided to Premera. It is used to set up the Vendor in Premera’s system. https://www.premera.com/documents/024063.doc
8.2 W9
This form is completed by the Vendor and provided to Premera. It is used to identify the Vendor’s tax identification number and certification. http://www.irs.gov/pub/irs-pdf/fw9.pdf
8.3 W8ECI Foreign
This form is completed by the Vendor and is provided to Premera when a Vendor is a non-U.S.- based company. The W8ECI form takes the place of the W-9 form to certify that all income is associated with trade or business within the U.S.
http://www.irs.gov/pub/irs-pdf/fw8eci.pdf
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8.4 Electronic Funding Authorization
This form is completed by the Vendor and provided to Premera. It is used by Premera to provide payment to Vendors via electronic bank transfer.
https://www.premera.com/documents/020758.doc
Completed forms can be sent to [email protected] or [email protected]
Section 9: Invoicing and Receiving Requirements
9.1 Invoicing Requirements
• Invoices must be from the Vendor directly—no third party invoices will be accepted or paid.
• The invoice must contain the valid purchase order (PO) number, a complete description or detail of work completed, and the per-unit cost or hours worked.
• Invoices must be released for payment in U.S. dollars.
• Invoices must include appropriate tax, indicated on a separate line.
9.2 Receiving Requirements
Premera, and particularly the business unit utilizing the Vendor’s service or product, must acknowledge in the Premera payment system that the service or product was received. This action, along with the Vendor’s invoice, will allow for funds to be dispersed for payment. When the invoices match the receipt, funds are automatically scheduled for payment. When the invoice does not match the receipt, manual intervention is required to resolve the issue.
Section 10: Policies
10.1 Gift Policy
Premera employees:
• Never accept cash
• Never ask for or solicit gifts, courtesies, meals, or entertainment
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• Never accept gratuities intended for purposes of influence
Premera employees may only accept unsolicited gifts and business courtesies under $75 in value.
Premera employees may offer or accept meals from an individual or entity with which Premera does business, but only if the offer extended is reasonable and appropriate for the business relationship. If the extended offer could be perceived as an attempt to gain any favor or influence, the employee will decline. Offers of entertainment, when extended within a group business setting, may be accepted by employee when it is reasonable and appropriate for the business relationship.
Employees who work with the government are prohibited from accepting gifts or anything of value –and– meals and entertainment from Vendors or potential Vendors.
10.2 Travel Guidelines
Travel and living expense reimbursement guidelines are stated in the Agreement. The Agreement will also specify whether Premera will allow such expenses.
Section 11: Frequently Asked Questions (FAQs)
11.1 FAQs
• As a potential new Vendor, what do I need to do first?
As outlined in the New Vendor Forms section, all new Vendors must complete the required set-up forms prior to work starting. Incomplete forms may postpone set up in the finance system.
• Once my Premera contact and I reach an agreement, when can I start work?
Work can begin with a fully executed agreement and a valid purchase order. Please remind your business contact of your need for a purchase order number before you can start work. Delays in payment may also result without a purchase order.
• When will I receive a PO?
After the contract is signed and the internal order process is completed, a purchase order will be generated and sent to the Vendor. Providing account manager or representative contact information on the Vendor Add form will ensure POs are issued quickly and accurately.
• Does every interaction require a formal contract to be negotiated?
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In instances where the good or service is “off the shelf” or a service has minimal risk or cost, Premera may determine that the formal contract process is not required. In these instances, only a purchase order will be issued and the Purchase Order Terms and Conditions will govern that transaction.
https://www.premera.com/documents/024061.pdf
• When can I submit an invoice?
Invoices may be sent after shipment of the goods and/or the completion of services or in accordance with specific agreed upon contract terms. Premera does not pre-pay for services; they are only paid as they are rendered.
For prompt payment, email all invoices and statements to our centralized Accounts Payable department at [email protected].
NOTE: For temporary labor, each invoice should be accompanied by the corresponding timesheet that has been approved by Premera management.
• Who do I contact for invoice inquiries?
Vendor and invoice issues are managed by Procure to Pay. If the invoice information provided is inaccurate or incomplete, you will be contacted by Procurement or Accounts Payable. For questions, please email [email protected].
• What are your net payment terms?
Standard payment terms are 2/10 Net 30 days from receipt of an undisputed invoice.
• How will I be paid?
Premera supports two payment methods for Vendors. The most efficient method is ACH payment to Vendors that have completed the Electronic Funding Authorization. (A copy is attached to this guide.) Premera will also issue paper checks. All invoices must be presented for payment in U.S. currency.
• I have already done work for Premera. Why do I need to sign a new contract?
Unless we have a master agreement, each new project requires a separate agreement. If there is a master, work assignments, statements of work or order forms are required.
• The work has changed—how do I submit a change order?
Vendors are required to work with their department contacts or directly with the contracting team to amend the agreement or a work assignment.
• I have more questions—who can I contact?
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Please refer to the contact list contained in this guide.
Section 12: Premera Key Contacts
12.1 Contact List
Name Title Phone Email Director, Enterprise Vendor Mark Thomas 425 918-5245 [email protected] Management and Contracts
Phyllis Benish Sr. Contract Specialist 425-918-8335 [email protected] Curt Jacobson Sr. Contract Specialist 425-918-6163 [email protected] Vannak Pok Contract Administrator 425-918-3622 [email protected] Pam Schriever Sr. Contract Specialist 425-918-3170 [email protected] Lea Smalls Sr. Contract Specialist 425-918-5456 [email protected] Vendor Management Justin Chan 425-918-5889 [email protected] Consultant Vendor Management Michael Festin 425-918-3574 [email protected] Consultant Vendor Management Sonja Wagner 425-918-4360 [email protected] Consultant Vendor Management Deanna Wermes 425-918-4250 [email protected] Consultant Sr. Vendor Management Dominic Wong 425-918-4312 [email protected] Consultant Procurement Procurement Dept. [email protected]
AP Accounts Payable Dept. [email protected]
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