07/27/2011
Pre-authorizations for select procedures for Regence MedAdvantage start Sept. 1, 2011
Starting Sept. 1, 2011, new pre-authorization requirements for select medical services will take effect for Regence MedAdvantage members. Pre-authorization services are performed to determine if services meet medical necessity criteria, assuring safety, effectiveness and appropriateness of treatment. Analysis has revealed several opportunities to use prior authorization to enhance quality of care while better managing cost.
Regence MedAdvantage members will need pre-authorization for the following services with a scheduled date of service of Sept. 1, 2011, or later:
- Hyperbaric oxygen therapy—involves breathing pure oxygen in a pressurized chamber; used to treat decompression sickness, serious infections and wounds, and other conditions
- Intensity modulated radiation therapy (IMRT)—an advanced type of 3D radiation that uses hundreds of small radiation beams of varying intensities to conform to a tumor's shape and precisely radiate it
- Negative pressure wound therapy—a therapeutic technique used to promote healing in acute or chronic wounds
We'll begin review for these treatments up to a month before the scheduled service to better coordinate with providers.
If you have any questions please call your Individual sales executive or Individual and Medicare Sales Producer Support at 1 (800) 557-0555.
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