| Case Management |
Regence Case Managers
are experienced registered nurses and social
workers who will provide one on one support
and guidance for any disease or health condition. |
| Clinical Practice Guidelines |
Regence supports the use of nationally
recognized practice guidelines to assist in determinations
of the clinical appropriateness of treatment
services. |
| Disease
Management |
Disease management programs
offer both early intervention and long-term
management of chronic conditions such as diabetes,
cardiac and respiratory conditions. Regence
currently offers two disease management programs:
|
| Medical Pre-authorization |
Pre-authorization is a prospective determination performed by licensed health-care professionals. The intent is to determine the medical necessity and appropriateness of the proposed treatment, level of care assessment and appropriate treatment setting.
Investigational services and supplies
Charges for investigational services and supplies are denied as provider write-offs unless the patient agrees in writing prior to receiving services to be financially responsible for the charges. View services and supplies currently considered investigational on the Regence Customized and Significant Clinical Edits list. |
| Pharmacy Prior Authorization |
Pharmacy prior authorization information
and forms are located on the RegenceRx® Web
site. |
| Special Beginnings® |
Our Special Beginnings® prenatal
program is used to provide education and support
to pregnant women to decrease the number of premature
deliveries and low birth weight infants. |
