| 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 pregnant women, at any risk level,
to decrease the number of premature deliveries
and low birth weight infants. |
