Provider data audit conducted this spring (5/7/12)
Your office may be contacted via phone by the Blue Cross and Blue Shield Association’s vendor, Thoroughbred Research, to answer questions related to your offices' information (e.g., name, address, phone number and specialty).
The information collected will be used to validate the data published on the National Blue Doctor & Hospital Finder website and the Federal Employee Program (FEP) Online Provider Directory website.
Thank you in advance for helping us ensure that the national directories are up-to-date.
Dental multi-year accumulators are now available on the Provider Center (05/2/2012)
The Provider Center now displays dental multi-year accumulators that are applicable to each member’s product.
The following information is displayed:
- Benefit limit
- What is remaining of the benefit
- When the benefit is available next
- What the patient has contributed to date
Example of how the information is displayed:
View our User’s Guide (PDF) for step-by-step instructions on verifying member information on the Provider Center.
Oregon Individual product and network changes starting October 1 (Updated - 05/04/2012)
Beginning October 1, at member’s benefit plan renewal dates, the following changes are being made to Oregon Evolve Individual and Family products:
Network changes – We have entered into a partnership with Adventist Health and Tuality Healthcare to provide in-network care to select Individual members in the Portland metropolitan area. Regence Individual members will be transitioned from their current PPO network to one of two Oregon Select networks. This move is designed to provide members continued quality care and monthly premium affordability. The Regence PPO network will no longer be available to Individual and Family members on all Regence Evolve plans in the Portland metropolitan area of Multnomah, Washington, Yamhill and Clackamas counties.
Note: This change does not affect your current Provider Agreement(s). This is a change in the Category 1 network for the Evolve Individual and Family products only.
For our members’ convenience, we’ve identified an Oregon Select network for them based on their proximity to network providers. Members will receive official notification of the change along with their options 90 days prior to their renewal date. Courtesy notification was mailed to all affected Portland members in April. Members will be moved to the pre-selected network automatically on their renewal date unless indicating they prefer the other Oregon Select network by submitting a Plan Change Request for Product Transition form (enclosed with their official notification) at least 60 days prior to the effective date.
Network pre-selection is based on members’ home ZIP code. A chart with network mapping is included here. New and existing members who want to find a provider in the either of the two identified Oregon Select networks can visit regence.com and click on “Find a Provider.”
Product changes – The following Regence Evolve Individual and Family products will be discontinued. (Note: This does not affect plans in Clark County, Washington).
- Evolve Core $1,000 deductible
- Evolve Plus $1,000 deductible
- Evolve Plus $2,500 deductible
- Evolve Plus $5,000 deductible
- Evolve Plus $7,500 deductible
We’ve identified an Evolve Core plan that may meet our member’s needs. Below is a chart showing the current plan and the new recommended plan. For example, if a member is currently on the Evolve Plus $1,000 deductible plan, they will be moved to the Evolve Core $2,500 deductible plan.
| Current Plan |
New Plan |
Plan |
Deductible |
Plan |
Deductible |
| Evolve Plus |
$1,000 |
Evolve Core |
$2,500 |
| Evolve Plus |
$2,500 |
Evolve Core |
$2,500 |
| Evolve Plus |
$5,000 |
Evolve Core |
$2,500 |
| Evolve Plus |
$7,500 |
Evolve Core |
$5,000 |
| Evolve Core |
$1,000 |
Evolve Core |
$2,500 |
Members will be moved automatically upon renewal to ensure there won’t be a break in coverage, unless they indicate otherwise by submitting a Plan Change Request for Product Transition form at least 60 days prior to the effective date.
Members will receive notification of the change along with their options 90 days prior to their renewal date.
To summarize the changes that will take place on benefit plan renewal:
- Some Evolve members will transition to a new product.
- Some Evolve members will transition to a new network.
- Some Evolve members will receive both a new product and a new network.
- Evolve members outside Portland who are on a product that remains open to new enrollment will not receive either of these changes and will go through rate renewal.
Regence MedAdvantage members receive annual wellness visit and preventive services materials (04/16/2012)
Beginning April 16, members will receive a letter and informational materials encouraging them to schedule and educating them about annual wellness visits or other preventive services available. See sample materials (PDF).
Regence Life and Health name change. (04/04/2012)
Effective April 1, Regence Life and Health Insurance Company is now LifeMap Assurance Company™ (LifeMap). Members will receive new member cards reflecting the new name. Please visit the LifeMap website at www.LifeMapCo.com for more information.
Sign-up to receive future communications from LifeMap.
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.
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. Payments were pended for one week while we investigated this issue. We have resolved the issue and pended claims will be released for payment.
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.
5010 999 transaction acknowledgement delays (03/09/2012)
We are currently experiencing unexpected delays in returning American National Standards Institute (ANSI) transaction acknowledgments (999s) to submitters. If you have not received an acknowledgment for your submitted files, please do not resubmit at this time.
We will post an update on the status of this issue, and when you can appropriately resubmit, as soon as possible. We apologize for any inconvenience this delay may cause.
We will soon require providers to access the Provider Center to verify information regarding member eligibility, benefits and claims information. (Updated 03/15/2012)
We will soon require dentists, physicians, other health care professionals and facilities to access the Provider Center to verify information regarding eligibility, benefits and simple claims status.
Most providers have found it’s faster to obtain this information online rather than waiting on hold for a Customer Service specialist. Using this free, online tool can save you up to five minutes per inquiry, and the information is available for most members Monday through Saturday 24 hours a day and on Sunday (except from 8 a.m. to noon for maintenance).
Customer Service will continue to be available to answer complex inquiries or questions you have about the information you are unable to view online.
Note:
Medical multi-year accumulators now available
The Provider Center now displays medical multi-year accumulators that are applicable to each member’s product. This information is not currently available for Federal Employee Program (FEP) or BlueCard members.
The following information is displayed:
- Benefit maximums
- How much of the benefit the member has remaining
- How much of the benefit the member has used to date
To see this information for your patients, simply navigate to the Medical Benefits, Multi-year Accumulators tab. From the drop-down menu, select the service. Then select ’Submit’. The multi-year accumulator information will be displayed below.
View our User's Guide (PDF) for step-by-step instructions on verifying member information on the Provider Center.
For past announcements, please view the What's New archive.
|
