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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
Obtaining medical policy information for out-of-area (BlueCard®) members: Use our online tool to be automatically routed to the home plan's medical policy information: Launch the tool |
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 section
for more information. |
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. |
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