| Policy |
Description |
| Appeal Policy |
An appeal is a request from a
facility, physician or health-care professional that
requires formal review because the complaint cannot
be resolved through initial research. Appeals may relate
to; 1) claims payment, handling or reimbursement for
health-care services, 2) matters pertaining to the contractual
relations between a physician or health-care professional
and Regence BlueShield of Idaho, and 3) other matters
as specifically required by state or federal law or
regulation. |
| Regence Medical
Policy |
The purpose of medical policy is to provide guidelines for determining coverage criteria for specific procedures, equipment, and services. |
| Regence 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. |
| Regence 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. |
| Covered Providers |
Provider types recognized as covered providers by Regence BlueShield of Idaho if all Regence requirements are met to be eligible as a covered provider. |
| Regence Behavioral Health Policy |
The purpose of the behavioral health policy is to provide a guide to coverage. Benefit determinations should be based in all cases on the applicable contract language. |
| Reimbursement
Policy |
A listing of reimbursement policies
utilized by Regence BlueShield of Idaho. |
