Regence contracts with physicians, dentists, other health care professionals and facilities to form provider networks essential for delivery of health care and dental services to our members. All providers must be credentialed before they can participate in Regence provider networks. Once credentials have been verified, a provider agreement is offered.
Contracting and credentialing steps:
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1. |
Review the list of provider
types to determine if we contract with your specialty
and if the network is open to participation |
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2. |
Register for the Provider
Center |
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3. |
Sign up for eContracting |
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4. |
Complete an application |
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5. |
If a network is closed to participation, complete the secure form to request a provider agreement should the network in your area open. We will contact you at that time with information about our contracting and credentialing process. |
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6. |
Once credentials are
verified, you will receive an email from our Credentialing
department. |
Benefits of Participation
- Claim payments are made to you directly on a weekly basis.
- Provider
consultants are available
to help you and your staff.
- You are listed in Regence Provider Search
(depending on the agreements you signed) made available
to Regence members.
- You may provide input on Regence policies. Learn
more.
- Regence members have financial incentives to seek
care from you because their expenses will be limited
to deductible, copayment and coinsurance amounts,
and charges for non-covered items. They may also
pay a lower deductible, copayment and/or coinsurance
if care is provided by a participating or preferred provider.
Responsibilities of Participation
As a participating provider, you have agreed to:
- Cooperate with our Member
Grievance and Appeal Procedures
- Bill Regence directly for covered services. Patients
should not be asked to submit claims.
- Abide by Regence policy guidelines as it pertains to the determination of claims for our members.
- Direct patients to physicians, other health care
professionals and facilities participating on the
network used by the member’s plan whenever possible.
- Accept our Maximum Allowable Fees (depending on
which agreements you have signed) as payment in full
for covered services for all Regence and affiliated
members.
- Your patients are only responsible for copayment,
coinsurance and deductible amounts, and for services
not covered by their benefit contract. Learn
more about hold harmless and calculating Maximum
Allowable Fees (PDF).
- Provide Regence with copies of members’ records (including X-rays), at no charge, when Regence requests records to make a claim determination. Provider must maintain records necessary to document the services for those claims submitted to us.
- Provide covered services to our members where such services are necessary and the provider is qualified to provide such services. In providing such services, the provider will meet the same standards of professional care that characterize the providers’ services to non-members.
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