| Case Management |
Regence Case Managers are experienced registered nurses and social workers who will provide one on one support and guidance for any disease or health condition. |
| Disease Management |
Disease management programs offer both early intervention and long-term
management of chronic conditions such as diabetes, cardiac and respiratory
conditions. Regence currently offers two disease management programs:
|
| Practice Guidelines |
Regence supports the use of nationally recognized practice guidelines to assist in determinations of the clinical appropriateness of treatment services. |
| Medical Pre-authorization |
Pre-authorization is a prospective determination performed by licensed health-care professionals. The intent is to determine the medical necessity and appropriateness of the proposed treatment, level of care assessment and appropriate treatment setting.
Investigational services and supplies
Charges for investigational services and supplies
are denied as provider write-offs unless the
patient agrees in writing prior to receiving
services to be financially responsible for
the charges. View
services and supplies currently considered
investigational on the Regence Customized and Significant Clinical Edits list.
|
| Pharmacy Prior Authorization |
Pharmacy prior authorization information and forms are located on the RegenceRx® Web site. |
| Special
Beginnings® |
Our Special Beginnings® prenatal
program is used to provide education and support
to pregnant women to decrease the number of premature
deliveries and low birth weight infants. |
