The Connection OnlineSM
December 2010
Welcome to The Connection Online
This publication contains important information, including updates to policies and procedures, for physicians, dentists, other health care and dental professionals, facilities and their staff.
If you haven't already, please subscribe to receive email notifications when new editions are available.
Help when you need it - When to use the Provider Center or contact us
Quickly find patient eligibility and benefit information online using our Provider Center. Customer Service can help answer complex inquiries and provide information that you cannot find online. In addition to offering your office training on our online tools and paperless options, our Provider Relations staff can support your office by answering inquiries not found using the Provider Center or by contacting Customer Service.
We hope this article makes it easier for you to quickly find the answers you need.
Radiology Quality Initiative (RQI) changes
We recently announced upcoming RQI program changes for our group and Individual products.
Effective with dates of service on or after September 1, if an order number has not been obtained from AIM for specific advanced imaging tests prior to performing the procedure, it will be denied as a provider write-off. This requirement applies to members enrolled on the following products:
- Uniform Medical Plan (UMP)
- Regence HSA Healthplan 2.0SM
- Regence Innova®, Engage® and ActivateSM
- Regence EvolveSM Individual and Family products
Medicare
News and Updates
- View all of our recent updates in the What's New section of our website.
Administrative and Billing
- Administrative Manual updates
- Behavioral health criteria changes
- Clinical practice guideline updated
- CPAP and BiPAP pre-authorization not required
- Electronic Data Interchange (EDI) news and updates
- HIPAA 5010 update
- National Provider Identifier (NPI) use update
- Pre-authorization reminders for skilled nursing and residential treatment centers
- Primary care, behavioral health and other specialties network survey coming soon
- Update your information in our Provider Directories
Products and Programs
Health Care Reform
Policies
Changes to our medical policies are listed below. Learn how policies are reviewed. Our Coding Toolkit includes codes that require clinical information (updated monthly), a complete list of code groupings and our Correct Code Editor (updated quarterly).
Medical
Reimbursement
Dental
View our Dental Policy Manual.
Medication
Learn how obsolete medication codes are reviewed on a quarterly basis.
Summaries of past changes and detailed policies are available in our Medication Policy Manual.
View our group and Individual products Preferred Medication List/Formulary.
Search the Regence MedAdvantage + Rx and Medicare Part D formulary.