Behavioral Health section to be removed (04/18/2012)
On May 1, the Behavioral Health link displayed in the left navigation will be removed. The behavioral health-specific treatment and pre-authorization forms previously in this section have been moved to the Forms and Pre-Authorization pages.
Important post-payment audit information (05/01/2012)
March is National Colorectal Cancer Awareness Month: View information about submitting routine colonoscopy and sigmoidoscopy claims to Regence under Federal Reform (03/01/2012)
New benefits added for Medicare (03/30/2012)
The Centers for Medicare & Medicaid Services (CMS) has recently issued several national coverage determinations (NCDs) that affect members with Medicare coverage:
The benefits added by these NCDs are available to Regence MedAdvantage members.
Dental Professionals section to be removed (3/30/2012)
On April 16, the Dental Professionals link displayed in the site navigation will be removed. All dental-specific information previously in this section has been incorporated into the general information for each topic throughout the site
You will find dental information in the following sections:
Delayed claim payments (updated on 03/09/2012)
We recently identified a claims pricing issue caused by a defect in the Trizetto upgrade install that affected claims received between February 5 and March 6, 2012. We will review all claims processed during this time period and will notify you regarding any needed adjustments.
All claims received after March 6, are processing correctly and, once completed, will be part of your regular payment schedule.
Outpatient diagnostic imaging services MUST have an order number from AIM (Updated to further clarify the program information on 3/02/2012)
Regence’s Radiology Quality Improvement Initiative (RQI) requires that an order number be obtained from American Imaging Management (AIM®) prior to the following advanced diagnostic imaging services for our group, Individual (commercial) and Regence MedAdvantage members:
- Nuclear cardiology
- Magnetic resonance imaging (MRI)
- Magnetic resonance angiography (MRA)
- Positron emission tomography (PET) studies
- Computerized tomography angiography (CTA)
- Outpatient elective computerized tomography (CT)
Failure to comply with the Regence RQI program will financially impact servicing provider practices and delay patient care. If an order number is not obtained, the service will be considered a provider write-off and cannot be billed to the member.
Obtaining an order number is a quick and easy process
AIM offers two methods for submitting imaging order requests, allowing provider offices quick access to complete imaging order requests in less than five minutes.
- Online: ProviderPortal is available 24 hours a day, seven days a week. Online tools assist with managing RQI processes such as checking the status of open requests, cancelling requests and changing servicing providers.
- Phone: Contact AIM’s call center at 1 (877) 291-0509 to submit order number requests.
Regence contracted servicing providers:
It is critical that radiology providers and free-standing imaging centers confirm that an order number has been obtained prior to performing the procedure. If an order number is not obtained, the procedure WILL NOT BE COVERED AND THE CHARGES WILL BECOME A PROVIDER WRITE-OFF.
Servicing providers can confirm order numbers by calling AIM or checking their ProviderPortal. If an order number has not been obtained, the servicing provider should request that the ordering provider contact AIM to obtain one.
Learn more.
Cenestin® moves to non-preferred medication status (03/01/2012)
Effective April 1, Cenestin will be a non-preferred medication for all Regence members, and will be subject to the non-preferred copayment. Our preferred alternatives to Cenestin are estradiol, estropipate and Enjuvia®. As always, we encourage members and providers to discuss preferred options to decide which medication is right for the member.
We make changes to the Preferred Medication List (PML) based on scientific evidence and a medication’s value compared to other medications. Learn more about our PML.
Regence partners with Altegra to assist Medicare “dual eligible” members (03/01/2012)
We have contracted with Altegra Health™ (Altegra) to reach out to our Medicare Advantage members who may be eligible to receive federal or state assistance to pay all or part of their Medicare Part B premium.
Certain Regence members may qualify for federal programs that provide Medicare beneficiaries with some type of financial relief. One of these programs, the Medicare Savings Program (MSP) helps pay for some or the entire Part B premium -- $99.90 in 2012. Another federal program, Extra Help, pays for some or all of a Medicare beneficiary’s Part D premium, reduces Medicare beneficiaries’ prescription drug copayment to as little as $1.10 per prescription, and provides protection through the coverage gap. In some cases, members may also be eligible for a State Medical Assistance Program.
This partnership is part of our ongoing efforts to deliver the highest service and value to our Medicare members. Altegra will assist our members by:
- Explaining the application process
- Answering any questions they might have
- Helping them complete any necessary forms
Altegra will implement the first phase of this program March 1 with calls to select members, followed by a mailing to Regence MedAdvantage members who are eligible and likely to enroll in the program. These mailings will begin the week of March 12.
Physician Satisfaction Survey (02/13/2012)
We appreciate all of the physicians who completed our annual Physician Satisfaction Survey in 2011.
Results indicate:
- 86% of physicians would likely continue to contract with Regence
- 76% of physicians felt Regence’s performance was better than other health plans
Our areas of strength include:
Suggested areas for improvement include:
- Member education – Visit myRegence.com to view the online tools and information available to our members
- Opportunities to provide input about Regence medical policies – Join our reviewer team
We appreciate the patience and support we received last year while we worked to bring all lines of business within our standard claims processing guidelines. As a reminder, you can save time and money by submitting claims electronically.
BlueCard® Customer Satisfaction Survey
Last year’s results indicate an overall increase in provider satisfaction with the program (compared to 2010 results).
Specifically providers reported increased satisfaction in the following areas:
- Timeliness of eligibility information
- Accuracy and timeliness of claims payment
- Efficiency of the pre-certification/pre-authorization process
We are pleased that our providers experienced these improvements related to out-of-area members.
Learn more about the BlueCard Program.
Clarification on Regence MedAdvantage vision claims submission (02/9/2012)
We have updated information about the recent change to the routine vision benefits on Regence MedAdvantage, including the relevant International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) codes to help you determine whether a claim is routine or not. Learn more.
Update your information in our Provider Directories (04/16/2012)
Please help us maintain accurate Provider Directories by completing the recently revised Provider Information Update Form when:
- A provider leaves or joins your clinic or practice
- You have a change to your organization's address, phone number, tax identification or National Provider Identifier number
The form can easily be submitted online or printed and faxed.
Thank you for your assistance in helping us keep critical information about your practice up-to-date.
New Practitioner Credentialing Application process eliminates need to mail paper applications.
View Availity’s HIPAA 5010 Frequently Asked Questions, including a list of common error messages and how to resolve them.
Reminder: Do not send X-rays with dental claims. Learn more about ADA J-400 claim form requirements.
Current Procedural Terminology (CPT®) code updates for 2012 (01/09/2012)
Claims pended for new codes
The Centers for Medicare & Medicaid Services (CMS) has added 250 new CPT codes effective January 1, and is in the process of assigning Relative Value Units (RVU) to them. As a result, we have been directed to temporarily pend claims that include these CPT codes until RVU’s are assigned and our systems are updated. We expect to begin processing these claims by mid-January.
Note: Claims with a pended status may not be available in the Provider Center.
2012 genetic testing codes
Effective January 1, the American Medical Association (AMA) added 101 new CPT molecular pathology (genetic testing) codes: CPT 81200-81408. While these codes are more specific than the existing codes, CMS has given these new codes a Status Indicator of “B” (Bundled Code) and has not assigned any pricing.
Instead, CMS will reimburse the existing genetic testing codes, according to their current policies. CMS has advised providers to bill both the existing codes and the new codes on the same claim. This will enable CMS to accumulate information to help establish pricing for these codes in 2013.
Regence has adopted the same approach regarding reimbursement of these new codes. We will deny new genetic testing codes as invalid or bundled and they will not be reimbursed. However, we will continue to reimburse the existing codes (e.g., CPT 83890-83914, 88363-88366, HCPCS G9143, S3800, S3818-S3890) in accordance with our Medical Policy.
We encourage providers to bill using the same process requested by CMS. This applies to all products, including group and Individual, Federal Employee Program, Uniform Medical Plan and Regence MedAdvantage.
View our Invalid Services (#107) reimbursement policy.
New preventive services benefits added for Medicare (01/05/2012)
The Centers for Medicare & Medicaid Services (CMS) has recently issued several national coverage determinations (NCDs) that affect members with Medicare coverage:
The benefits added by these NCDs are available to Regence MedAdvantage members under their preventive care benefits with no copayment, coinsurance or deductible when services are rendered by primary care providers.
Annual Wellness Visit Program updates (12/30/2011)
We are making a few updates to the Annual Wellness Visit Program for 2012.
If you have received a request for medical records for the Annual Wellness Visit Program, please submit them promptly to receive your payment. Payments for this program are sent quarterly. Effective February 1, physicians and other health care professionals who have enrolled in the Annual Wellness Visit Program but have not submitted requested charts will be removed from the program. Impacted providers have been notified via email.
To be eligible for Annual Wellness Visit Program payment:
- Beginning April 1, requested charts must be received within 60 days
- Documentation for wellness visits must substantiate that the provider addressed all required visit components. Providers should identify chronic diseases, injury risks, modifiable risk factors and urgent health needs of the patient as well. Learn more about the eligible codes and visit components.
The Annual Wellness Visit Program encourages Regence MedAdvantage members to schedule an annual wellness visit with their physician or other health care professional. Find out how to participate.
Generic Lipitor® now available (12/21/11)
The Food and Drug Administration (FDA) has approved the first generic version of the cholesterol-lowering drug atorvastatin (Lipitor®).
What is the difference between atorvastatin and the other generic statin medications?
- Atorvastatin is the first generic high-potency statin available. It may be helpful for people who need to lower their LDL-C by more than 40%. Atorvastatin is the most expensive generic option and requires prior authorization.
- There are several well known generic low-potency statins available. They are helpful for people who need to lower their LDL-C by up to 40%. They offer a good value and are available without prior authorization. They include:
- simvastatin (Zocor®)
- pravastatin (Pravachol®)
- lovastatin (Mevacor®)
Do all high-potency statins require prior authorization?
In support of the best value generic statins, RegenceRx will continue to require prior authorization of new prescriptions for high-potency statins, including generic atorvastatin, Crestor®, Vytorin®, and Lipitor®.
How will generic atorvastatin be covered for group and Individual product members?
When prior authorization of generic atorvastatin is approved, it will be covered at the generic copayment.
How will generic atorvastatin be covered for Medicare Part D members?
Members with Medicare Part D coverage will be able to receive generic atorvastatin without prior authorization at the non-preferred generic copayment tier.
What are the specific details for prior authorization of high potency statins?
- Generic atorvastatin and Crestor may be covered when a generic low-potency statin is not effective in obtaining the LDL-C lowering needed or when the member needs LDL-C lowering more than 40%.
- Brand name Lipitor and Vytorin may be covered when treatment with generic atorvastatin or Crestor is not effective.
- Members currently taking brand name Lipitor will be able to switch to generic atorvastatin without prior authorization.
What other resources are available?
To learn more about statin medications, view our ConsumerRx medication summary.
Generic atorvastatin will be included in our Half Tablet Program.
View our statin medication policy.
View our pharmacy prior authorization form.
If you have questions or need additional information, please call Pharmacy Customer Service at 1(800) 643-5918.
Prior authorization to be required for brand name antipsychotic medications beginning in January (12/21/11)
Effective January 1, 2012, prior authorization will be required for coverage of new prescriptions for the following brand-name atypical antipsychotics:
- Abilify®
- Fanapt®
- Geodon®
- Invega®
- Latuda®
- Saphris®
These medications may be covered when generic antipsychotics are ineffective, not tolerated or contraindicated.
Recently, several commonly-prescribed antipsychotics have become available generically, such as olanzapine (Zyprexa) and risperidone (Risperdal). We encourage the use of these generic options, as they remain the best values for most of our members.
What is the coverage policy?
Regence:
View our specific coverage policies for atypical antipsychotics:
How can I obtain prior authorization for my patient?
Complete our prior authorization request form.
What if my patients are already established on therapy?
Prior authorization will be needed only for new prescriptions. Members currently using a brand-name antipsychotic will not need prior authorization.
If you have any questions, please contact Pharmacy Customer Service at (800) 643-5918.
Medical pre-authorization lists updated, effective January 1, 2012: Group and Individual, Medicare and Uniform Medical Plan
Uniform Medical Plan claims processing update (1/18/11)
Holiday office closure schedule - New Year's (12/27/11)
Our offices will be closed on Monday, January 2 in observance of New Year’s Day.
Holiday office closure schedule - Christmas (12/19/11)
Our offices will be closed on Friday, December 23 and Monday, December 26 in observance of Christmas.
Survey for Regence MedAdvantage providers (12/08/11)
Regence MedAdvantage network providers recently received a letter requesting they participate in a short network availability survey.
The letter included a personalized password for your clinic. Please use this password to complete the survey online by December 31.
Once you open the survey and enter your password, you will see a list of physicians or other health care professionals under your tax identification number who currently participate in the Regence MedAdvantage network. For each provider, please indicate if he or she:
- Was accepting new Regence MedAdvantage patients on January 1, 2011
- Will be accepting new Regence MedAdvantage patients on December 31, 2011
If you have difficulty accessing the survey or need your password, please contact your provider consultant.
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