Contracts/Credentialing Guidelines

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Provider Types

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Contracts/Credentialing Guidelines

Physicians, dentists, other health care professionals and facilities must first complete a credentialing application before they can participate in Regence provider networks. Prior to submitting a credentialing application, please review the list of Provider Types to determine if we contract with your specialty and if the network is open to participation. You may also sign up for eContracting, which allows you to receive notification of provider agreements and amendments through the convenience of your personal email. Learn more about eContracting and sign up.

Credentialing applications are usually processed within 45 days of receipt. During peak application periods (usually spring and summer) this processing time may increase. Please ensure that applications are completed in their entirety, are signed and all supporting documentation included as incomplete applications will delay processing time.

Participating Effective Date Policy

The following policy applies to all participating providers:

New provider agreements will have an effective date of the first day of the month in which the credentialing was approved (e.g., if credentialing was approved on June 14, the agreement will be effective on June 1).
If a signed agreement is not received in the same month as the credentialing is completed, the agreement effective date will be the first of the month in which credentialing is approved or the signed agreement is received, whichever is later.
A new provider joining a group or clinic agreement will have an effective date of the first day of the month in which he or she was credentialed (e.g., if credentialing was approved on June 14, the effective date of participation will be June 1).
If a provider already participating with Regence adds an additional network, the effective date of the new network will be the first day of the month the signed agreement is received.
Retroactive agreement effective dates are not permitted.
Claims submitted for dates of service prior to the agreement effective date will be processed as out-of-network.

Contracting and Credentialing Forms

Type	Instructions	Criteria	Forms
Providers Physicians and other health care professionals.	Review the credentialing criteria and complete an application. Return completed and signed Practitioner Credentialing Applications by email or Fax to 1 (888) 335-3002. Please do not mail paper applications to Regence.	Practitioner Credentialing Criteria for Participation and Termination (PDF) (Effective 1/1/2012)	Practitioner Credentialing Application (PDF)
TriWest/TRICARE TriWest Healthcare Alliance (TriWest) is contracted with the U.S. Department of Defense for the administration of the TRICARE program in the West Region.			Complete both of the following: Practitioner Credentialing Application (PDF) TRICARE Supplemental Credentialing Questionnaire (PDF)
Organizations All organizational providers (facilities) are required to complete the credentialing process prior to contracting with Regence. The recredentialing process must also be completed at a minimum of every three years.	Review the credentialing criteria and complete an application. Return completed Universal Facility Applications to: Regence Credentialing Department PO Box 21267 M/S 5555 Seattle, WA 98111-3267 Fax: 1 (888) 335-3002 Email	Organizational Provider Credentialing Criteria for Participation and Termination (PDF) (Effective 1/1/2012)	Organizational Provider/ Facility Credentialing/ Recredentialing Application (PDF)
Hospital and Free-Standing Facility Based Practitioner Information Form Practitioner who practices exclusively within a hospital setting, inpatient setting, or free-standing facility setting, meets our credentialing and contracting criteria and provides care for Regence members only as a result of members being directed to the hospital or other inpatient setting.	Use this form when a provider is being added to a hospital, inpatient or free-standing facility location. Return completed Hospital and Free-Standing Facility Based Practitioner Information Form to the address or fax number listed on the form.		Hospital and Free-Standing Facility Based Practitioner Information Form (PDF)
Dental	Review the credentialing criteria and complete an application. Return completed and signed Practitioner Credentialing Applications by email or Fax to 1 (800) 331-3505.	Practitioner Credentialing Criteria for Participation and Termination (PDF) (Effective 1/1/2012)	Practitioner Credentialing Application (PDF)

Indian or Tribal Health Clinic credentialing requirements

We require that all Indian or Tribal Health providers complete the credentialing process prior to contracting. These providers are required to complete the recredentialing process at a minimum of every three years.


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