November 2009
Procedures and services deemed investigational or not medically necessary
We recently mailed amendments/addendums to our provider agreements. The changes (effective January 1, 2010 for Oregon-based providers and February 1, 2010 for Clark County-based providers) are summarized below:
Written consent is not required for services deemed investigational. However, we encourage providers to notify the member before services are rendered that they may be deemed non-covered and will be the member's financial responsibility.
Note: The Regence Clinical Edits by Code lists contain investigational codes and supporting documentation requirements.
Participating providers in Clark County only
Medical Necessity and Medically Necessary: Effective January 1, 2010, WAC 284-53-010 requires carriers to utilize a definition for Medical Necessity and Medically Necessary that is specific to chemical dependency services. The definition for Medical Necessity and Medically Necessary has been updated to be compliant with WAC 284-53-010.