The following information and resources are offered to provide support to physicians, other health care professionals and their staff:
| Case Management |
Regence Case Managers
are experienced registered nurses and social
workers who will provide one on one support and
guidance for any disease or health condition. |
| Clinical Practice Guidelines |
Regence supports the use of nationally
recognized practice guidelines to assist in determinations
of the clinical appropriateness of treatment services. |
| Disease Management |
Disease management programs offer
both early intervention and long-term management
of chronic conditions such as diabetes, cardiac
and respiratory conditions. Regence currently
offers two disease management programs:
|
| Medical Pre-authorization |
Pre-authorization is a prospective
determination performed by licensed health-care
professionals. The intent is to determine the
medical necessity and appropriateness of the
proposed treatment, level of care assessment
and appropriate treatment setting.
Investigational services and supplies
Charges for investigational services and supplies
are denied as provider write-offs unless the
patient agrees in writing prior to receiving
services to be financially responsible for
the charges. View
services and supplies currently considered
investigational on the Regence Customized and Significant Clinical Edits list. |
| Pharmacy Prior Authorization |
Pharmacy prior authorization information
and forms are located on the RegenceRx® Web
site. |
| Special
Beginnings® |
Our Special Beginnings® prenatal
program is used to provide education and support
pregnant women, at any risk level, to decrease
the number of premature deliveries and low birth
weight infants. |
