Policy Updates

Changes to our medical policies are posted online by the tenth of each month and are also published in our online provider newsletter.

Requests for review of a medical policy determination can be submitted using the Medical Policy Form. The request should include additional references or literature that may not have been reviewed in the initial policy determination. Use the Adverse Determination Appeals Process for billing dispute and medical necessity/investigational procedure determinations.

Medical Policy Review Request

Submit disagreements with a medical policy determination made by the Medical Policy Workgroup for review. The request should include additional references or literature not reviewed in the initial policy determination. For specific claim billing disputes, review our appeals process.

External Medical Advisors

Participating physicians and other health care professionals from each specialty area serve as External Medical Advisors to Regence’s Medical Policy Workgroup. External Medical Advisors receive medical policy drafts for review and provide their input electronically. Providers interested in providing feedback on policies in their draft form can complete an online request form.

As a Regence provider, you may review existing medical policies and provide your feedback. You can also contact your provider consultant either by phone or in writing. If you have questions about an existing policy, contact your provider consultant to find out what information was considered in establishing the policy.

Revised February 2010

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