3/4/14 - ACA provision for non-discrimination against providers
The Affordable Care Act (ACA) includes a provision prohibiting health insurance companies from certain types of discrimination against any health care provider. We are applying this new regulation to our Individual and Group products as issued or renewed on or after January 1, 2014.
Under this new provision, when an alternative care provider, such as a chiropractor, acupuncturist or massage therapist, provides any service covered in an insurance plan, the provider is eligible for reimbursement, as long as that provider is licensed by his or her state, the service is within that provider’s scope of practice, and the provider complies with our Utilization Management requirements.
There are no changes to excluded services, such as massage therapy and acupuncture.
Example: A member has injured her back and needs physical therapy treatment. Physical therapy is covered by her health insurance plan. She can seek services from an orthopedist, an osteopathic physician, a naturopathic physician, a chiropractor, an acupuncturist, or a massage therapist, as long as that provider is licensed in his/her state, physical therapy is within his/her scope of practice, and the provider followed our Physical Medicine Program requirements. The service will be covered at the in-network or out-of-network benefit level, depending on the provider’s participating network status.
2/24/14 - Medicare Advantage members receive Passport to Health
This month, our Medicare Advantage members will receive their Passport to Health (PDF) – a list of preventive screenings available to them at no cost through their Medicare plan. We are encouraging members to bring this checklist to their providers as a tool to discuss their overall health and how to live a healthy lifestyle.
Members will also be able to download the Passport to Health online beginning February 28 by clicking on “View member information” after they enter their ZIP Code.
2/19/14 - Tools and resources to help keep your patients’ hearts healthy
As part of American Heart Month, we are sharing tips for a healthy heart with our members. These tips from cardiologist Dr. Eric Stecker encourage members to:
- Be active
- Learn CPR
- Lose weight
- Quit smoking
- Reduce stress
- Know their risks
- Take their medications
- Be familiar with their heart beat
We have several care management programs (PDF) and resources designed to support our members at any stage of health, including the following that emphasize heart health:
- Quit For Life®: This program helps members develop a personal plan to become tobacco-free.
- Health coaches: Our health coaches provide one-on-one support for your patients to set and reach goals for a healthier lifestyle.
- Case Management: This program provides members who are facing a serious or sudden medical situation easy access to a case manager.
- Regence Condition Manager: This program assists patients with conditions, including congestive heart failure and coronary artery disease.
To request a patient assessment for our Care Management programs, please call
1 (866) 543-5765 or complete our online assessment form.
1/29/14 - 2014 codes added to our system edits - Please resubmit denied claims
There was a delay in adding some of the new 2014 codes to our system editing software which may have created claim denials. If you received any claim denials (the upfront denials appear on submission reports), please resubmit any impacted claims.
Our editing software was updated on January 17 to include the new codes and claims are now being processed correctly. We apologize for any inconvenience.
1/16/14 - ACA’s 90-day grace period for health exchange enrollees to pay premiums
Under the rules of the Affordable Care Act (ACA), a patient on an exchange product who receives a premium subsidy from the government has a grace period of up to three months to pay premiums before their coverage is cancelled. During this grace period, insurers may not disenroll members. However, insurers are not obligated to pay claims incurred during the second and third month if a member’s premium is unpaid.
Insurers are required to notify providers in the second and third month of the grace period about the possibility that claims may be denied in the event that the member’s premium is not paid. Notifications should meet state and federal requirements and include the claim number, name of plan, and explanation of the three-month grace period, the purpose of the notice and Customer Service phone numbers.
If the member’s outstanding premium is paid in full by the end of the grace period, any pended claims will be processed in accordance with the terms of the contract.
Regence does not offer products on the exchange. Learn more about the Individual and Family exchange products offered in Utah through healthcare.gov.
1/16/14 -2014 member benefit booklets delayed
Printing of our 2014 contract and benefit booklets for employer groups with two to 99 employees will be delayed until April. Please access Availity’s medical or dental web portal to obtain the most up-to-date benefits and eligibility information.
For past announcements, please view the What's New archive.