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Provider Incentive Plans
Any provider incentive plans established by Regence BlueShield shall be designed to improve the quality and efficiency of health care provided to its members.
If a provider incentive plan is based on the utilization of health care services, the plan must contain mechanisms to ensure that members are receiving medically necessary health care.
Such mechanisms may include, but are not limited to:
- audits of case files
- overall assessment of causes of utilization pattern variation, and
- offsetting financial incentives that relate to quality
Policies
Regence BlueShield uses Policies as guidelines for coverage determinations in all health care insurance products, unless otherwise indicated. For more information about specific policies, select the appropriate manual:
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