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Provider Manual

Our manuals contain dental and medical policy and procedure information that can be used as a day-to-day reference by our providers and their staff.

Notification of content changes
Updates to manual sections are posted at the beginning of the month in which they occur and a notification is included in our newsletter, The Connection OnlineSM. Our newsletter is published in February, April, June, August, October and December. Sign up to receive our newsletters via email. Please review new content promptly to ensure you have the most current information.

Learn more about Regence, view our Code of Business Conduct policy or our Confidentiality information and requirements.

Core Manual    
Section Change
Revision Date
Appeals Added External Reviewer contact information to the Provider external review process 6/2011
Behavioral Health Updated the Milliman Care Guidelines information
12/2011

BlueCard® Program

 Converted to Web-based format
5/2010

Boeing

Converted to Web-based format. Added to 2010 benefit information

 1/2010
Care Management Added information about our Integrated Care Management program
1/2012
Credentialing

Converted to Web-based format
8/2010

Facility Guidelines
Includes: Inpatient, Outpatient, Freestanding ASC, Hospice, Skilled Nursing, Home Health, Home Infusion Therapy, Home Medical Equipment & Prosthetic Devices and Ambulance

 Added sales tax information in the Home Medical Equipment & Prosthetic Devices section 10/2011
Federal Employee Program (FEP) Added 2012 benefit information 1/2012
Filing Claims Added ICD-10 information, other billing information and an updated dental billing link
3/2012
Fraud and Abuse Converted to Web-based format
4/2010
Healthy Options / State Children's Health Insurance Plan (SCHIP) (PDF) Added the Health Care Authority's fax number for prior authorizations
4/2012
Identifying Members (PDF)

Added information about Regence RealValueSM member cards.
5/2012
Medicare Advantage Plans

Updated benefit information for 2012

 1/2012
Payment (PDF)

Added information about redesigned Regence MedAdvantage vouchers
1/2011
Quality Program Added information about Physician Quality Measurement (PQM) and Blue Physician Recognition (BPR) Programs
4/2012
Regence Life and Health Dental Products (PDF) Updated contact information
12/2011

Regence Policies

  • Dental
  • Medical
  • Medication
  • Reimbursement
 Section renamed. Dental policy information added. 8/2011
RegenceRx Provider Basics Converted to Web-based format
5/2010
Selections® Section removed. This product is no longer available.
5/2012


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Professional Manual    
Section Change
Revision Date
Alternative Care (PDF)

Section format changed and content updated to reflect current processes and information

10/2011
Home Medical Equipment & Prosthetics Converted to Web-based format
12/2011
Laboratory Services (PDF)

Section format changed and content updated to reflect current processes and information
10/2011
Obstetrical Care

This section is removed and replaced by our Maternity Care Reimbursement Policy
4/2012
Practitioner Guidelines (PDF) Added provider responsibility information
10/2011
Radiological Services (PDF)

Section format changed and content updated to reflect current processes and information
10/2011
Regence Life and Health Voluntary Dental (PDF)    
Therapy Guidelines (PDF)

Section format changed and content updated to reflect current processes and information
10/2011
Vision (PDF)

Section format changed and content updated to reflect current processes and information
10/2011

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