| Dental Library
The Dental Library contains various Dental
Manuals, Dental
ProVisions, forms,
list of covered MedAdvantage
Preventive dental services, and House
Bill 1418 ‘Overpayment Recovery Practice’
- Dental Manuals
The Regence Group® Dental Policy Manual and The
Regence BlueShield Dental Provider Manual are both
available online.
- Dental News
Dental News are published by the Communications
Division of Regence BlueShield. They are written to keep our providers aware of our
programs, guidelines and policies.
To print or search
within the newsletter, use our new Dental News-only search
tool. View instructions to search
within a PDF file or to print
sections of a PDF document.
- Forms
This forms library contains information change request
forms, overpayment/voucher deduction request and more.
House Bill 1418 ‘ Overpayment Recovery
Practice’
On January 1, 2006,
House Bill 1418 ‘Insurance
Overpayment Recovery’ (RCW 48.43.600), goes into
effect. This new law requires that carriers provide
prior written notification within 24 months after the
date that the payment was made to a health care provider
when the refund is requested or 30 months for a coordination
of benefits (COB) refund.
Exclusions to Overpayment Recovery Practice:
- Claims for FEP members will continue to follow
our current process for refunds.
Effective January 1, 2006, written refund requests
will be sent to vouchered providers included in the
new legislation. In most cases Regence BlueShield will
notify the provider of a refund by displaying the claim
number(s) impacted for each member, on the weekly voucher
pend report that is included with your remittance advice.
The pend report is currently in use and is used to
notify your office of any claims being held for additional
information, such as preexisting information or coordination
of benefits. As of January 2006, the pend report will
now include claim(s) holding for refund notification,
along with the dollar amount of the refund and the
reason we are requesting the refund.
Refund requests for special circumstances, COB and
other party liability (OPL) claims will require a letter
to be sent instead of the pend report. For easy identification,
the letters will be mailed to your office in a bright
orange envelope.
Once you have been notified of the refund, your office
will have 30 days to respond. To expedite the refund
process, please respond immediately.
- If Regence BlueShield has no response after 30
days, the refund will be released and automatically
deducted on a future voucher.
- If your office needs additional time to refund
the amount due, your office can contact us and make
arrangements for repayment. You may take up to six
months to complete the repayment.
If you have a question regarding the original claim
related to the refund request, you can also use Regence
Online Service for Providers (ROS-P) to view a remittance
advice or check on the claim status.
Finalizing the refund request
To
help assist you in reducing the administrative burden
this new legislation may cause, you can advise Regence
BlueShield on how to proceed with the refund request.
The following options are available:
Email our Refund Department(s)
regencerecovery@regence.com
Call Customer Service
1 (800)
848-5424
Fax the pend report. Indicate
on the pend report (per claim) how to handle the
refund (ok to process, or hold for repayment) and
fax to Regence BlueShield.
(206) 626-6227
Mail notification to:
P.O. Box
21267, Seattle WA 98111-3267
If you have any questions or concerns regarding this
new legislation, please call your professional relations
representative.
Other Links
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