We contract 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 our provider networks. Interested in joining our provider network? Use our provider onboarding resource to get started.
For providers who are not joining an existing group, the last step of the onboarding process is to sign agreement documents. You will receive an email instructing you how to review and sign your agreement documents. Please be sure to add @DocuSign.net to your address book to avoid filtering by anti-spam software.
Note: Documents must be signed by an authorized officer within your group to be legally binding. They cannot be signed with the clinic name.
Within 10 business days of signing your agreement documents, you will be loaded to our system as a participating provider. You will receive an email notification that confirms your participation on our network(s) and includes your effective date of participation. If you are joining an existing agreement for a contracted tax ID, you will be added to that agreement and will not have to sign agreement documents. The tax ID owner will be notified of your network participation effective date. Claims submitted before your effective date of participation will be processed as out-of-network.
The following agreement and provider effective date policy applies to all participating providers:
- Providers will only be offered a provider agreement after the credentialing process has been completed.
- The effective date for a provider's participation in any given network, the effective date of a new provider agreement, or a provider agreement renewal, will be the:
- Date the credentialing application is considered complete, or the date requested on the credentialing application, whichever is later. An application is determined to be complete as part of the credentialing approval process. Note: We suggest that you hold claims for your Regence patients until after you receive notification of approval so claims will be paid at the in-network rate and won’t have to be reprocessed
- Date the agreement is signed for a newly credentialed, new-to-Regence provider. See more information below.
Agreement receipt date
Effective date of participation
Newly credentialed or existing providers requesting a new agreement (ancillary facility or professional agreement)
Signed agreement received between the 1st and 15th of the month
Example: Signed agreement received 8/05/2020
1st of the month following receipt of the signed agreements
Example: Effective date 9/01/2020
Signed agreement received between the 16th and end of the month
Example: Signed agreement received 8/20/2020
15th of the month following receipt of the signed agreements
Example: Effective date 9/15/2020
Newly credentialed providers joining an existing medical group agreement
Date the complete credentialing application is received, or the date requested on the credentialing application, whichever is later. An application is determined to be complete as part of the credentialing approval process.
Existing credentialed provider joining an existing medical group agreement
Notification of joining MGA received between the 1st and 15th of the month
Example: MGA notification received 8/05/2020
1st of the month following notification of joining MGA
Example: Effective date 9/01/2020
Notification of joining MGA received between the 16th and end of the month
Example: MGA notification received 8/20/2020
15th of the month following notification of joining MGA
Example: Effective date 9/15/2020
Medical groups with delegated credentialing
Notification of provider joining delegated group can be received at anytime
Example: Delegation notification with a Credentialing Committee approval date of 8/5/2020 and an effective date of 8/10/2020
Date provided by delegate
Example: Effective date 8/10/2020
- You may provide input on our policies.
- Claim payments are made to you directly on a weekly basis.
- Our Provider Contact Center is available to help you and your staff.
- You are listed in our provider search (depending on the agreements you signed) made available to our members.
Our 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.
As a participating provider, you have agreed to:
- Cooperate with our Member Grievance and Appeal Procedures.
- Bill us directly for covered services. Patients should not be asked to submit claims.
- Abide by our policy guidelines as it pertains to the determination of claims for our members.
- Consider privacy concerning care and confidentiality in all communication and medical records.
- 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 our members and affiliated members.
- Ensure that all subcontractors are subject to and comply with the terms of the Participating Provider Agreement and all applicable Federal and State statutes, laws and regulations.
- Provide us with copies of members' records (including x-Rays), at no charge, when we request records to make a claim determination. Providers must maintain records necessary to document the services for those claims submitted to us.
- Not discriminate against any member and to treat all members with dignity, respect, and courtesy regardless of race, physical or mental ability, ethnicity, gender, sexual orientation, creed, age, religion or national origin, cultural or education background, economic or health status.
- 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.
- Assume responsibility for your relationship with each patient and are solely responsible for the medical care provided, including the discussion of treatment alternatives. Your Agreement does not limit your right to communicate freely with your patients, including the right to inform them services are appropriate or necessary, even if we determine the services are not covered by their plan.
- Bill us directly for covered services provided to our members in accordance with your participating agreement. A licensed provider may not submit claims for services performed by and on behalf of (i.e., incident to) another provider or Non-Physician Practitioner (NPP). Palliative care services are an exception to this. We do not accept claims for, or provide coverage for, services rendered as part of a residency or fellowship program. Claims should not be submitted under the name and identifier of the attending or supervising provider.
Hold patients responsible only for copayment, coinsurance and deductible amounts, and for services not covered by their benefit contract. If you bill a member prior to the processing of a claim, the bill should clearly indicate that you have submitted the claim to us. Prior to processing of the claim, you may require member payment only for services known to be non-covered and estimated copayment, coinsurance and deductible amounts.
To maintain compliance with the Affordable Care Act (ACA) and the Centers for Medicare & Medicaid Services (CMS) requirements for Medicare Advantage Plans, it is your responsibility to notify us promptly of any changes to your practice.
Providers whose contract status has lapsed more than 30 days will be required to resubmit an initial credentialing application. Not having an active practice location is considered a lapse.
You can complete a Provider Information Update Form for any of the following changes:
- Phone number
- Organization's address
- Accepting new patients
- Offering telehealth services
- eContracting email address
- Request a roster for validation
- Changing organization ownership
- Practice data validation email address
- National Provider Identifier (NPI) number
- Providers joining or leaving your clinic or practice
- Changing where your payments should be directed
Changing your tax ID number (include a copy of your 147c letter from the IRS)
If your clinic or facility submits provider rosters to us, please submit changes, corrections, additions or terminations immediately so that we can update the information that is displayed in our online directories as soon as possible. Your roster must be reviewed and validated in its entirety at least once per quarter and you must reply to any requests for roster review.
The following changes must be submitted in writing via certified mail:
- Terminating a network affiliation
- Removing one provider from a group contract only requires a Provider Information Update Form be submitted
Closing a practice
Complete the Electronic Contracting Registration form to:
- Register for electronic contracting
Update information for the individual designated with the authority to review and sign agreement documents on your behalf (your legal signatory)
You also have a responsibility to verify the information we list about your practice in our directories every 30 days. To review your directory listing, please follow these steps.
Provider reimbursement schedules and other pricing documents are available to contracted providers after logging into the Availity Provider Portal: Payer Spaces>Resources.