Regence Policies
Regence Medical Policies are developed to provide guidance for members and
providers regarding coverage in accordance with contract terms. Benefit determinations
are based in all cases on the applicable contract language. To the extent there
may be any conflict between the Medical Policy and contract language, the contract
language takes precedence.
Newly established or revised medical, reimbursement and administrative policies
and information on quality improvement activities may be communicated in our
newsletter, The
Connection OnlineSM, or by letter. It is important that
physicians, other health care professionals, facilities and their staff review
each issue to keep abreast of these policies.
For more information about specific policies, select the appropriate manual:
| Medical and Reimbursement Policy
Manuals |
Description |
| Medical
Policy |
The purpose of medical policy is to provide guidelines
for determining coverage criteria for specific procedures, equipment
and services. The Introduction section of this manual includes information
about:
- Selecting Technologies
- Research Sources
- Technology Assessment
- Approval process
NOTE: Regence Medical Policy does not apply to Medicare and Regence
MedAdvantage. Review the Medicare
Advantage Plans (PDF) section for more information.
Your patients may ask questions regarding Regence Medical Policy, as
our policies are also available to our members on www.regence.com |
Reimbursement
Policy |
These policies document Regence payment policy
and correct coding for medical and surgical services and supplies.
|
Dental
Policy |
Dental policies have been developed
through consideration of government approval
status, dental necessity, generally accepted
standards of dental practice and review of dental
literature. |
Medication
Policy |
Regence medication policies are
based upon research of scientific literature,
government approval status, and evidence-based
treatment guidelines supporting clinical best
practice/standards of care. |
Revised August 2011
|
