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Regence MedAdvantage
Regence MedAdvantage is a Medicare Advantage (MA) Preferred Provider Organization (PPO) product available to eligible Medicare beneficiaries.
Required training
Providers and their staff are responsible for annual training on:
- Medicare compliance
- Medicare fraud and abuse
Complete the annual training now.
Provider networks
Regence MedAdvantage members can seek services from our Regence MedAdvantage participating providers or from non-participating providers. Please be sure to validate your information in our Provider Directory. You can also create or enhance your provider profile from within the Provider Center.
Regence participates in MA PPO network sharing with other Blue Cross and/or Blue Shield Plans (Blue Plans). Regence MedAdvantage providers whose patients are MA PPO members from other Blue Plans will:
- Be reimbursed using Regence MedAdvantage contracted rates
- Receive payment for in-network benefits according to the member’s contract
- Extend the same contractual access to care to these members as Regence MedAdvantage members
If you are providing services for a patient with a Medicare Advantage Private Fee-for-Service (PFFS) plan, you can access the Medicare Advantage PFFS terms & conditions using the Web Finder Tool.
We are actively contracting with physicians, other health care professionals and facilities to be included in our Regence MedAdvantage Network. Learn more about joining this network.
Product features
- No referral requirements
- No copayment or deductible for Medicare-covered preventive services
- Includes all Medicare Part A and B benefits with additional covered services
- Most professional services are covered at 100% after a copayment, or paid in full for in-network providers
Service area: Clallam, Columbia, Cowlitz, Island, King, Kitsap, Klickitat, Lewis, Pierce, San Juan, Skagit, Skamania, Snohomish, Thurston, Wahkiakum, Walla Walla, Whatcom and Yakima counties
Routine vision
We have partnered with Vision Service Plan® (VSP) for routine vision examinations and hardware. VSP administers claims processing, customer service and provider service calls for all routine vision benefits. You can reach them at 1 (800) 877-7195 or TDD 1 (800) 428-4833.
- Regence MedAdvantage members must see a VSP Signature network provider to receive in-network benefits for routine vision services
- The out-of-network allowed amount for routine vision exams is $45 after copayment
- All claims for the following routine services as well as applicable routine vision hardware claims should be directed to VSP for claims processing:
CPT or HCPCS code |
Description |
92002 |
Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient |
92004 |
Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits |
92012 |
Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient |
92014 |
Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits |
92015 |
Determination of refractive state |
92310 |
Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia |
92311 |
Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, 1 eye |
92312 |
Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, both eyes |
92326 |
Replacement of contact lens |
S0500 |
Disposable contact lens, per lens |
S0620 |
Routine ophthalmological examination including refraction; new patient |
S0621 |
Routine ophthalmological examination including refraction; established patient |
If we receive a claim for one of these services, it will be denied with instructions to submit the claim to VSP for processing, if you are a VSP participating provider. If you do not participate with VSP as a routine vision provider, the member should submit a receipt to VSP for reimbursement according to the assigned out-of-network allowed amount.
Continue to submit claims for all other vision services to Regence.
Preventive dental
Participating dental contracted rates apply for Regence MedAdvantage members for covered services. Members pay 20% coinsurance. The annual benefit maximum is $500 for the following preventive dental services:
- Cleanings - two per calendar year
- Panoramic film - once every three calendar years
- Examinations - two per calendar year (any combination)
- Bitewings - two per calendar year (any combination)
- Fluoride - two times per calendar year for members age 17 and under
- Sealants, on permanent bicuspid and molars - for members age 17 and under
Dental codes that are covered for Regence MedAdvantage:
- D0120 Periodic oral evaluation
- D0150 Comprehensive oral evaluation - new or established patient
- D0240 Intraoral - occlusal film
- D0270 Bitewing - single film
- D0272 Bitewings - two films
- D0274 Bitewings - four films
- D0330 Panoramic film
- D1110 Prophylaxis - adult
- D1120 Prophylaxis - child
- D1201 Topical application of fluoride (including prophylaxis) - child
- D1203 Topical application of fluoride (prophylaxis not included) - child
- D1351 Sealant
- D4910 Periodontal maintenance
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