The following information describes the general Idaho Power coverage. This information is NOT to be relied upon as pre-authorization or pre-certification for health care services and is NOT a guarantee of payment.

Important pre-authorization reminders

1. Before requesting pre-authorization, please verify eligibility and benefits via the Provider Center.
2. Verify that you are an in-network provider for each member to help reduce his or her out-of-pocket expense.
3. Verification of member eligibility is valid if obtained within five business days of service except in the case of misrepresentation.
4. Pre-authorizations obtained within 30 business days prior to service are valid except in the case of misrepresentation.
5. Medical policies related to specific pre-authorization requirements are available.
6. Pharmacy prior authorization information and forms can be found at the RegenceRx Physician Web site.
7. Please note that a pre-authorization does not guarantee payment for requested services. Regence reimbursement policies may affect how claims are reimbursed and payment of benefits is subject to all plan provisions, including eligibility for benefits.
8. Pre-authorization approval will be communicated by phone and a pre-authorization approval number will be provided.
9. Pre-authorization denials will be communicated both in writing and by phone.

Pre-authorization for investigational services and supplies is not required as such charges are typically contract exclusions and ineligible for payment. Charges for investigational services and supplies are denied with financial responsibility assigned to the member.

Potentially investigational services are services that are considered investigational, but for select diagnoses, may also be considered medically necessary.  Unlisted codes may be appropriate to use for potentially investigational services and are subject to review. 

• View investigational and potentially investigational procedures on the current Regence Clinical Edits by Code list.
• View a sample non-covered services member consent form (PDF).

• Detox/Inpatient/Partial admissions: Notification upon admission required; concurrent review will occur after 2 days.
• Chemical dependency intensive outpatient: Notification upon admission required; concurrent review will occur after 8 weeks.
• Outpatient mental health, outpatient chemical dependency, and intensive outpatient mental health: Concurrent review will occur after 20 visits.
• Residential Treatment Center (RTC): Pre-authorization is required prior to patient admission.

Durable medical equipment (DME) greater than a $1,500 purchase or $125 rental/month

• Transplants

HCPCS codes G0341, G0342, G0343,  S2053, S2054, S2055, S2060, S2065, S2140, S2142, S2150, S2152

• Transplants, donor services

• All hospital admissions require notification - Concurrent review will occur after 7 days.
• Inpatient Rehabilitation - Pre-authorization is required prior to patient admission.
• Skilled nursing facility (SNF), transitional care unit (TCU) - Pre-authorization is required prior to patient admission.
• Long Term Acute Care (LTAC) - Pre-authorization is required prior to patient admission.

• Spinal fusion, inpatient only

• Other spinal surgery and related procedures (effective March 1, 2012)

CPT codes 22100, 22110, 22206, 22210, 22220, 22325, 22520, 22521, 22522, 22523, 22524, 22525, 22532, 22548, 22551, 22554, 22558, 22600, 22612, 22630, 22633  22800, 22808, 22818, 22520, 22521, 22522, 22523, 22524, 22525, 72291 and 72292

• Hip, knee, or shoulder total joint replacement and revision of hip, knee, or shoulder joint replacement (effective March 1, 2012)

CPT codes 23470, 23472, 27125, 27130, 27132, 27134, 27137, 27138, 27438, 27440, 27442, 27445, 27446, 27447, 27486, 27487 and 27488

• Hysterectomy, inpatient only (effective March 1, 2012)

• Abdominal wall hernia repair, inpatient only(effective March 1, 2012)

• Any surgical procedure combined with a policy exclusion or cosmetic procedure

• Home Health care

• Genetic testing

CPT codes: 83890-83898, 83900-83916, 86305, 88384-88386

HCPCS codes: S3800, S3818-S3870, S3890

• Outpatient cardiac and pulmonary rehabilitation

Including but not limited to the following codes:

CPT codes 93797, 93798, HCPCS codes G0422, G0423, S9472 for cardiac rehabilitation

• Parenteral, enteral and oral nutrition therapy

• Orthognathic surgery

• Varicose vein surgery

• Potentially cosmetic procedures to restore or improve appearance that may also correct a functional impairment.

Pre-authorization not required for initial breast reconstruction one or two stages and nipple/areola reconstruction following mastectomy.

Please refer to the Regence Clinical Edits by Code list for cosmetic and potentially cosmetic procedures.

Blepharoplasty CPT codes15820, 15821, 15822, and 15823 may be potentially cosmetic.

• Potentially investigational services that are considered investigational, but for select diagnoses, may also be considered medically necessary.

May not be covered under the member's contract. However, pre-authorization is recommended for any policy that has specific medical necessity criteria in addition to the experimental and investigational language.

Unlisted codes may be used for potentially investigational services and are subject to review. 

Please refer to the Regence Clinical Edits by Code list for additional information.

Regence has partnered with American Imaging Management (AIM_®) to administer the Regence Radiology Quality Initiative (RQI). As part of that initiative, effective September 1, 2011, order numbers must be obtained through AIM for the advanced diagnostic imaging services listed below:

• Nuclear cardiology
• Magnetic resonance imaging (MRI)
• Magnetic resonance angiography (MRA)
• Positron emission tomography (PET) studies
• Computerized tomography angiography (CTA)
• Outpatient elective computerized tomography (CT)

Login to AIM’s ProviderPortal or phone 1 (877) 291-0509