Find a doctor Find a dentist Contact us

Sign in

Individuals & Families Medicare For Employers For Producers For Providers

Don't have a member account yet? Create one

Sign in

Individuals & Families Medicare For Employers For Producers For Providers

Don't have a member account yet? Create one

Find a doctor Find a dentist Contact us

Go to Regence home page

Attention!

You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association.

Loading...

Behavioral health facility submission forms

Required for services beginning May 1, 2022. Tip: Download the form and then fill it out to avoid browser discrepancies.

Attention!

You are about to leave our Medicare website.

© 2025 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington.