Important pre-authorization reminders

1. Before requesting pre-authorization, please verify eligibility and benefits via the Provider Center.
2. Verification of member eligibility is valid if obtained within five business days of service except in the case of misrepresentation.
3. Pre-authorizations obtained within 30 business days prior to service are valid except in the case of misrepresentation.
4. Medical policies related to specific pre-authorization requirements are available.
5. Potentially investigational services may also be considered medically necessary for select diagnoses. Please refer to the Regence Clinical Edits by Code list for additional information. Unlisted codes may be used for potentially investigational services and are subject to review. 
6. Some member contracts have specific pre-authorization requirements. The member's contract language will apply.
7. Urgent/Emergent services do not require pre-authorization.
8. Pharmacy prior authorization information and forms can be found at the RegenceRx Physician Web site.
9. 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.

Upcoming List:

• Effective February 1, 2010

Current List:

• Effective May 1, 2009

Previous Lists:

• Effective February 1, 2009
• Effective July 1, 2007 (PDF)
  • List with CPT/HCPCS codes
• Effective January 1, 2007 (PDF)

Complete this form to facilitate the pre-authorization process for medical, surgical or DME services.

Statement of Medical Necessity for Oncotype DX (PDF)

This form is used to facilitate medical necessity for Oncotype Dx® Breast Cancer Assay. Codes include S3854 and 84999. Fax completed forms to 1 (800) 453-4341