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Provider Manual

Core Manual

Section
Change
Revision Date
Introduction (PDF) Updated newsletter and confidentiality information.
11/2009
Who to Contact Information moved to Contact Us and other sections of our Web Site.
11/2009
Credentialing (PDF) Formatting changes.
11/2008
Identifying Members (PDF)

Added updated member card backs for Regence InnovaSM, EngageSM, ActivateSM and Regence HSA Healthplan 2.0SM, and Regence MedAdvantageTM member card samples.
5/2009
Filing Claims (PDF) Minor text changes and updated UB-04 section.
11/2009
Forms (PDF)  
8/2008
Payment (PDF) Minor text changes and updated Innova, Engage, Activate, HSA Healthplan 2.0 and BlueCard claim voucher samples.
11/2009
Appeals (PDF)

Effective 1/15/09.
10/15/2008
Fraud and Abuse (PDF) Expanded section to include topics related to preventing fraud, External Audit, Federal False Claims Act and member card fraud.
11/2009
Medical and Reimbursement Policy (PDF) Updated medical and reimbursement policy review processes.
5/2009
Care Management (PDF) Formatting changes. Now includes Advicare information.
11/2008
Quality Program (PDF) Applied formatting changes and added Radiology Quality Initiative language.
5/2009
Medicare Beneficiaries (PDF)  
8/2008
Behavioral Health (PDF) New section. Replaces the Behavioral Health Manual.
2/2009

Provider Center
(formerly known as  Regence Online Services for Providers)

 Updated references to the name of the tool.
11/2009
RegenceRx Provider Basics (PDF) Formatting changes.
11/2008
BlueCard® (PDF) Formatting changes.
11/2008
Product Overview New section.
2/2009
Boeing (PDF) Updated to include 2009 benefit information. Applied formatting changes.
5/2009
Federal Employee Program (FEP) (PDF) Formatting changes.
2/2009
Healthy Options / State Children's Health Insurance Plan (SCHIP) (PDF) Updated information and applied formatting changes.
5/2009

Medicare Advantage Plans (PDF) (Effective through 12/31/2009)

Medicare Advantage Plans (PDF) (Effective 1/1/2010)

 

 

Added 2010 benefit summaries, new member card samples and changed appeal language.

 

 

11/2009
Selections® (PDF) Formatting changes.
5/2009
Self-Managed and Consumer Directed Products

Updated deductible options for Innova and Engage.
8/2009
Glossary (PDF) Added definitions related to Self-Managed and Consumer Directed products.
2/2009


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Professional Manual

Section
Change
Revision Date
Alternative Care (PDF)  
08/2008
Home Medical Equipment & Prosthetics (PDF)  
08/2008
Laboratory Services (PDF)  
08/2008
Obstetrical Care (PDF)  
08/2008
Practitioner Guidelines (PDF)  
08/2008
Radiological Services (PDF)  
08/2008
Therapy Guidelines (PDF) Speech therapy guidelines revised.
11/2009
Vision (PDF)  
08/2008

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Facility Manual

Section
Change
Revision Date
Ambulance (PDF)  
08/2008
Freestanding Ambulatory Surgical Centers (PDF)  
08/2008
Home Health (PDF)  
08/2008
Home Infusion (PDF)  
08/2008
Hospice (PDF)  
08/2008
Home Medical Equipment And Prosthetic Devices (PDF)  
08/2008
Hospital Guidelines (PDF)  
08/2008
Skilled Nursing (PDF)  
08/2008

 

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