The Connection OnlineSM
April 2010
Welcome to The Connection Online
This publication contains important information, including updates to policies and procedures, for physicians, dentists, other health care and dental professionals, facilities and their staff.
Editions are published in February, April, June, August, October and December. As a reminder, our newsletter will be published online only. You will no longer receive paper issues of The ConnectionSM or Dental News.
If you haven't already, please subscribe to receive email notifications when new editions are available.
Note: Other important updates can be found in our What's New section.
Our Provider Center can save you time
Our Provider Center is a free, secure Web-based tool that allows physicians, dentists, other health care and dental professionals, facilities and their staff access to valuable information for most Regence members.
Web-based transactions now available through
Office Ally
Office Ally, a full service clearinghouse, offers free, Web-based transmission and tracking for CMS-1500, UB-04 and American Dental Association (ADA) J400-J404 claim forms through Health Insurance Portability and Accountability Act (HIPAA)-compliant transactions.
Enhanced Provider Profile benefits
Thank you to the nearly 17,000 providers who have created an Enhanced Provider Profile, allowing more than 550,000 members to utilize this sought-after information.
Improved hospital comparison tool
Our improved hospital comparison tool, available on myRegence.com, helps members easily choose a hospital, using criteria important to them, for the care they need.
HealthyLifeSM booklet available for your waiting area
Printed copies of our new myRegence.com HealthyLife booklet are available for provider office waiting areas.
Administrative and Billing
- Administrative Manual updates
- A new year means new member cards
- Avoid electronic claim filing errors
- Behavioral health utilization management requirements update
- Modifiers required for visits during surgery global periods
- Pre-authorization/Pre-certification information easier to access for BlueCard members
- Preferred network names now available on many member cards
- Regence prepares for HIPAA 5010
- Restricting disclosure of patient protected information
- Verify validity of modifiers
Products and Programs
- e-Prescribing resources and tools available
- Generic medication programs
- Medical record documentation standards audit
- Medication Cost Integration launched
- Potential adverse interactions between Plavix® and proton pump inhibitors
- Provider components of the 2010 Quality Program
- Weight management programs and assistance for children and adults
- Women's wellness survey results for Boeing members
Policies
Changes to our medical and reimbursement policies are listed below. Learn how policies are reviewed. Our Coding Toolkit includes codes that require clinical information (updated monthly), a complete list of code groupings and our Correct Code Editor (updated quarterly).
Medical
- ConsumerTxSM summaries for your patients
- CPT 31641 deemed potentially investigational
- Investigational and medical necessity reviews
Reimbursement
- Appropriate use of Modifier -59
- Change to Modifier -22 with anesthesia codes
- Effective date change for specialty pharmaceutical reimbursement
Medication
Summaries of recent changes (PDF) and detailed policies are available in our Medication Policy Manual.
View our group and Individual products Preferred Medication List/Formulary.
Search the Regence MedAdvantage + Rx and Medicare Part D formulary.