November 2009
Procedures and services deemed investigational or not medically necessary
In September, we mailed amendments/addendums to our provider agreements. The changes, effective January 1, 2010, are summarized below:
Prior to rendering services deemed investigational to members enrolled in Medicaid and Healthy Options Basic Health, the provider must obtain the member's written consent in order to charge the member. For all other members, written consent is not required for services deemed investigational. However, Regence encourages the provider to notify the member before services are rendered that they may be deemed non-covered and, if non-covered, will be the member's financial responsibility.
Note: The Regence Clinical Edits by Code lists contain investigational codes and supporting documentation requirements.