Supporting Documentation

When Regence requests your office to submit supporting documentation, it is typically indicated by the message code on your payment voucher. The Regence Clinical Edit List contains the supporting documentation requirements of most services and supplies, listed by CPT and HCPCS code.

To submit documentation for electronic or paper claims, please use the Supporting Documentation Coversheet (PDF). This is a standard cover sheet for submitting medical information in support of a claim. Using this cover sheet will ensure that documentation is “attached” to the right claim(s) and will expedite processing. You may also use this form when you know in advance that Regence requires a report (such as an unlisted procedure code).

• Complete all fields on the form.
• Include claim number on form when submitting.
• Do not use for corrected billings or billing disputes.
• Indicate if claim was submitted electronically if applicable.
• Complete all member information.
• Include the office contact information.
• Identify in the comment section, what type of documentation you are attaching.
• Mail the completed form with the additional documentation to the address on the back of the member card.