Reimbursement Policy Disclaimer
The Reimbursement Policy Manual is intended only for
physicians and other health care professionals,
except where otherwise indicated.
By clicking “I Accept” below, you acknowledge
your understanding and agreement with the following:
Description
The Regence BlueCross BlueShield of Oregon Reimbursement
Policy Manual documents payment methodology for medical
and surgical services and supplies. THIS REIMBURSEMENT
POLICY DOES NOT APPLY TO ANY OTHER COMPANY.
Use
Reimbursement Policy is used by Regence to provide consistent
and predictable claims payment.
Conflict with Other Documents
Reimbursement Policy facilitates the systematic
application of Regence member contracts, provider
contracts, and medical policies. These documents
will govern in the event of a conflict with the Reimbursement
Policy.
Restrictions and Limitations
- Reimbursement Policy shall be interpreted and
modified in the sole discretion of Regence.
- Reimbursement Policy does not determine the
schedule of benefits. Rather, Reimbursement Policy
supports the schedule of benefits by establishing
payment rules, coding hierarchy and related processing
systems’ edits.
- The coding software guidelines are incorporated
into the Reimbursement Policy by reference. Thus,
to the extent there are situations not documented
in the Reimbursement Policy, coding software guidelines
control.
- Reimbursement Policy does not dictate to other
BlueCross BlueShield plans how to set allowables
for their providers under BlueCard plans.
- Health care facilities, physicians and other
health care providers are expected to exercise
their medical judgment in providing the most appropriate
care. Reimbursement policy is not
intended to dictate medical practice and does
not constitute medical advice.
- Reimbursement Policy is the property of Regence
and you are strictly prohibited from using it
for any commercial use whatsoever. Commercial
use does not include use of the Reimbursement
Policy related to benefit payment for health care
services received by a Regence member.
- Current Procedural Terminology CPT™ codes
and descriptions are the property of the American
Medical Association with all rights reserved.
You are strictly prohibited from using CPT™ codes
for any unauthorized use whatsoever.
- Reimbursement Policy may be revised from time
to time. Regence will provide ninety (90)
days written notice of Reimbursement Policy changes
that result in a reduction to compensation.
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