Regence contracts with physicians, dentists, other health care professionals and facilities to form provider networks essential for delivery of health care and dental services to our members. All providers must be credentialed before they can participate in Regence provider networks. Once credentials have been verified, a provider agreement is offered.
Contracting and credentialing steps:
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1. |
Review the list of provider types to determine if we contract with your specialty and if the network is open to participation |
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2. |
Register for the Provider Center |
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3. |
Complete an application |
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4. |
Sign up for eContracting |
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5. |
If a network is closed to participation, complete the secure form to request a provider agreement should the network in your area open. We will contact you at that time with information about our contracting and credentialing process. |
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6. |
Once credentials are verified, you will receive an email from our Credentialing department. |
Benefits of Participation
- Claim payments are made to you directly on a weekly basis.
- Provider
relations
representatives and provider consultants and dental services representatives are available to help you and your staff.
- You
are listed in Regence provider listings (depending
on the agreements you signed) made available to Regence members.
- You may provide input on Regence policies. Learn
more.
- Regence members have financial incentives
to seek care from you because their expenses will
be limited to deductible, copayment and coinsurance
amounts, and charges for non-covered items. They
may also pay a lower deductible, copayment and/or
coinsurance if care is provided by a participating
or preferred provider.
Responsibilities of Participation
As a participating
provider, you have agreed to:
- Cooperate with our Member
Grievance and Appeal Procedures
- Bill Regence directly for covered services. Patients
should not be asked to submit claims.
- Abide by Regence policy guidelines as it pertains to the determination of claims for our members.
- Direct
patients to physicians, other health care professionals
and facilities participating on the network used
by the member’s plan whenever possible.
- Accept
our Maximum Allowable Fees (depending on which agreements
you have signed) as payment in full for covered services
for all Regence and affiliated members.
- Your patients
are only responsible for copayment, coinsurance and
deductible amounts, and for services not covered
by their benefit contract. Learn
more about hold harmless and calculating Maximum
Allowable Fees
(PDF).
- Provide Regence with copies of members’ records (including X-rays), at no charge, when Regence requests records to make a claim determination. Provider must maintain records necessary to document the services for those claims submitted to us.
- Provide covered services to our members where such services are necessary and the provider is qualified to provide such services. In providing such services, the provider will meet the same standards of professional care that characterize the providers’ services to non-members.
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