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Commercial Medical Provider Networks
Participating (PAR)
The Regence BlueCross BlueShield of Oregon (Regence BCBSO) Participating (PAR) Network supports all traditional and indemnity lines of business, and serves as the default for all other networks in Oregon and Clark County, Washington. As the default, the participating provider agreement is the baseline for all other provider agreements. All providers must sign a participating agreement before joining any other Regence BCBSO provider network.
The PAR Network is also used for Regence BCBSO affiliates and subsidiaries and other Blue Cross or Blue Shield Plans (Blue Plans) through the BlueCard® Program.
Preferred Provider
Plan (PPP, PPO)
The Regence BCBSO Preferred Provider Plan (PPP) Network supports our preferred business and the Federal Employee Program. This network is available in Oregon and Clark County, Washington.
The PPP Network is used for Regence BCBSO affiliates and subsidiaries and Blue Plans through the BlueCard Program.
Oregon Select Networks
The five Oregon Select Networks are used for preferred products offered by Regence BCBSO in Multnomah, Washington, Clackamas, and Columbia counties in Oregon, and Clark County, Washington. Participation in these networks is by invitation only.
Each network is centered around one of the five major integrated health care delivery systems in the Portland metropolitan area and includes their network of referral health care professionals.
- Oregon Select Tuality
- Oregon Select Providence
- Oregon Select Legacy Health
- Oregon Select Adventist Health
- Oregon Select Oregon Health & Science University (OHSU)
Medicare Provider Networks
Regence MedAdvantage
Our Regence MedAdvantage products use the Regence BCBSO MedAdvantage Network for in-network services with no referral requirements to access specialty care. Regence MedAdvantage provides all Part A and B benefits with additional covered services in one plan.
The Regence MedAdvantage service area includes Benton, Clackamas, Clatsop, Columbia, Coos, Curry, Douglas, Hood River, Jackson, Josephine, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington and Yamhill counties in Oregon and Clark County in Washington.
Dental Networks
Contracting and Participating Dental Agreements
Regence contracts with multiple dental professionals, forming dental networks to meet our members' needs. In return we offer predictable reimbursement amounts and schedules, direct payment, and a pool of potential patients.
Participating Dental
The Participating Dental Network serves our members enrolled in our participating fee-for service dental plans in Oregon and southwest Washington. Participating dentists and dental professionals are reimbursed according to our maximum allowable fee schedule. Payments and a remittance statement (which explains payment for services provided to our members) are sent directly to participating dental offices each week.
Willamette Dental
We offer dental products through Willamette Dental Group (WDG), a Dental Health Maintenance Organization (DHMO). Members located within 50 miles of a contracted Willamette Dental Group office may be offered this product for their dental care needs. Offices are located in Oregon, Washington, and Idaho.
Participating Dental Agreements
Regence has standardized contracting practices and uses a single Dental Group Agreement for multiple providers using a Federal tax identification (ID) number. This agreement will cover all providers doing business under that tax ID number. Providers using their Social Security Number (SSN) will receive an Individual Dental Provider Agreement.
To participate on our dental networks:
- Review the list of provider types to determine if we contract with your speciality and if the network is open to participation.
- Complete a Provider Application
- Login to Provider Center
- Download the Provider Application in the Reference Library
- If you do not have a Provider Center account, please register
- Sign up for eContracting.
Application Checklist
The following is a checklist of documents that must be legible and included with your Application:
- A photocopy of your current state dental license (with license number, issue date and expiration date).
- A photocopy of your specialty certification(s)/or general anesthesia or conscious sedation permits, if applicable.
- A photocopy of your current malpractice insurance certificate (with policy number, levels of individual aggregate coverage and dates of coverage).
- A photocopy of your current Drug Enforcement Administration certificate(s), if applicable.
- A W-9 indicating how the tax ID is registered with the IRS.
Dental Fee Schedule
How Payment is Calculated for Participating Dental Products
Every spring we review Regence dental maximum allowable fees to ensure that fees are within community standards. This process includes a review of claims submitted during the past year by dentists within Regence BCBSO's service area of the state of Oregon and SW Washington. We also add a trending factor, which allows us to adjust for inflation. The results are above the range for average charges for a service or supply billed by most providers or vendors for the same or similar service or supply in our service area.
A Maximum Allowable Fee is determined for each service or supply provided to your patients. The Maximum Allowable Fee amount is the total amount you can expect to receive in payment from the patient and payor combined.
Our Participating Dental Maximum Allowable Fee Schedule along with the Federal Employee Program (FEP) Basic Option and Standard Option dental fee schedules are available online for participating dental professionals who have access to Provider Center.
If you are a participating dental professional, but you do not have Provider Center access, please contact our dental services representatives directly to request a copy of our fee schedules.
How Payment is Calculated for non-participating Dental Products
Generally, we use an amount, determined by us, which falls within the range of average charges for a service or supply billed by most dental professionals for the same or similar service or supply in our service area.
However, there are times when we will create a special fee schedule to fit a particular niche product. For example, the BlueCare Fee Schedule below was created for our BlueCare dental product, an alternative for our small group market.
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