Our policies are used as guidelines
for coverage determinations in all health care insurance
products, unless otherwise indicated. Benefit determinations
are based on applicable member contract language. Plan
language will be followed if there are any conflicts
between these Policies and the Plan.
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:
| Policy |
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. |
| Behavioral
Health Policy |
These policies are developed using evidence-based
treatment guidelines as well as clinical best practices/standards
of care. They are consistent with Milliman, Substance
Abuse and Mental Health Services Administration
(SAMHSA) and culturally competent practice
philosophy and standards. |
Reimbursement
Policy |
These policies document Regence payment policy
and correct coding for medical and surgical services
and supplies. |
| Other
Manuals |
Description |
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. |
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