Why Regence health insurance?
The Regence Group is a nonprofit Blue Cross Blue Shield licensed health insurance company. It's health insurance plans are under the Blue Cross Blue Shield name in …
When should I hold claims for my Regence patients?
The Regence Group is a nonprofit Blue Cross Blue Shield licensed health insurance company. It's health insurance plans are under the Blue Cross Blue Shield name in …
How much does Regence pay for in-network care?
Newly credentialed or existing providers requesting a new agreement (ancillary facility or professional agreement) Signed agreement received between the 1st and 15th of the month. Example: Signed agreement received 8/05/2020. 1st of the month following receipt of the signed agreements. Example: Effective date 9/01/2020.
Electronic authorizations
Use Availity’s electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. Some procedures may also receive instant approval.
Pharmacy
View medication policies and pre-authorization requirements. Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx.
What is CMS in healthcare?
To maintain compliance with the Affordable Care Act (ACA) and the Centers for Medicare & Medicaid Services (CMS) requirements for Medicare Advantage Plans, it is your responsibility to notify us promptly of any changes to your practice.
Can a claim be submitted under the name of the attending or supervising provider?
Claims should not be submitted under the name and identifier of the attending or supervising provider. Hold patients responsible only for copayment, coinsurance and deductible amounts, and for services not covered by their benefit contract.
Why choose Regence
See how our affordable Regence plans offer coverage, access and convenience—so you can live your best.
Standing together, no matter the distance
We’re proud to stand with you during this challenging time. See what we’re doing in your community to keep people safe and healthy.
What is the number for the Medical Benefit Booklet?
If you have further questions—like if you'll need a prescription or if you're limited to a number of visits—reach out to Customer Service at 1 (844) REGENCE (734-3623) .
What to do in an emergency situation?
In an emergency situation, call 911 or go to the nearest emergency room. Hospital care outside of your service area is a covered benefit. In- or out-of-network benefits will apply depending on your insurance plan. In an emergency situation, prompt care comes first.
What is copayment in medical insurance?
Copayments are the fixed dollar amount that you must pay directly to the provider for an office visit, emergency room visit or prescription medication each time you receive a service or medication. To understand what copayments you are responsible for, refer to the Medical Benefits section of your benefit booklet. To find your benefit booklet, sign in to and go to the Benefits page.
What happens if a doctor does not get pre-authorization?
If a doctor does not get pre-authorization before treating you, your health plan will not cover those costs and the doctor may bill you for that treatment. If you use an in-network doctor, you don't need to do anything. The doctor's office will handle the pre-authorization process.
What is a medical emergency?
A medical emergency is when you believe that you have medical symptoms that require immediate medical attention to prevent loss of life, loss of a limb, or loss of function of a limb. The symptoms may be an illness, injury, severe pain or a medical condition that is quickly getting worse.
What to do if you have an emergency?
If you have an emergency, call 911 or go to the nearest emergency room. If you need care outside of regular business hours and it isn't an emergency situation, first call your doctor's office to see if your doctor or provider has extended office hours.
What is a PCP?
Your primary care provider (PCP) is the best person to help you find and get care from specialists, behavioral health care providers and hospitals. For this reason, we suggest that you establish a relationship with a PCP of your choice, even if it is not required by your plan.
How it works
Search for a procedure or test—if several options pop up, select the best match. You can filter your results by specialty, hospital, pricing, location and more.
Use the Cost Estimator to
Get your estimated out-of-pocket expenses for common medical conditions, surgeries, tests and exams