Contracting

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.

Signing your agreement documents

After completion of the credentialing process, you will receive an email instructing you how to review and sign your agreement documents. Please be sure to add econtracting@regence.com and @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.

DocuSign
You will receive an email with a link to review your agreement documents in DocuSign. Follow the on-screen instructions to review each page and electronically sign your agreement. You will receive an email with a copy of your agreement after you have signed. You have the option to create a free DocuSign account for easy access to your agreement documents that require a signature, but it is not required. If signatures are not required, you will receive an email with a copy of your agreement documents.

eContracting Center
You will receive an email with a link to review your agreement in our eContracting Center. An Availity Provider Portal account is required in order to access the eContracting Center.

If signatures are required:

  • You will be notified by email that agreement documents are available. That email will contain an eContracting Center (ECC) code.
  • You will be directed to sign in to the Availity Portal. Select the eContracting Center link under Resources in Payer Spaces.
  • Once in the eContracting Center, you will enter the ECC code contained in the email.
  • You may then download the documents for review and accept or reject the documents with your electronic signature.
  • You may also save the agreement documents for future reference.
    If signatures are not required:
  • You will be notified by email that agreement documents are available.
  • You will be given a link in the email to the documents.
  • You may download the documents for review and save them for future reference

Sign up for eContracting

If you are not already receiving your agreement documents electronically, please sign up for eContracting by completing a Provider Information Update Form. You can also update your practice information including the individual you designate with the authority to sign agreement documents on your behalf.

Determining your participation effective date

Agreement documents will be fully executed within 10 business days of your signing. You will receive an email notification that confirms your participation on our network(s) and includes your effective date of participation. Claims submitted before your effective date of participation will be processed as out-of-network.

The following contract and provider effective date policy applies to all participating providers:

  • Providers will only be offered a provider contract (agreement) after the credentialing process has been completed as stated within the above Credentialing Program Description.
  • The effective date for a provider's participation in any given network, or the effective date of a new provider agreement, or a provider agreement renewal, will be limited to the first (1st) or fifteenth (15th) day of the month, or as otherwise stated in this policy.

New standard provider agreements (professional, medical group, dental, ancillary, facility):

After credentialing is approved and complete, the effective date of a provider agreement for a new provider will be effective on the 1st or the 15th of the following month or as noted below.

Agreement type

Agreement receipt date

Effective date of participation

Ancillary facility and professional agreements (newly credentialed and existing)

Signed agreement received between the 1st and 15th of the month

Example: Signed agreement received 8/05/15

1st of the month following receipt of the signed agreements

Example: Signed agreement received 8/05/15

Signed agreement received between the 16th and end of the month

Example: Signed agreement received 8/20/15

15th of the month following receipt of the signed agreements

Example: Effective date 9/15/15

Medical group agreements (MGA) (newly credentialed)

Credentialing approved between the 1st and 15th of the month

Example: Credentialing Approved 8/05/15

1st of the month following credentialing approval

Example: Effective date 9/01/15

Credentialing approved between the 16th and end of the month

Example: Credentialing Approved 8/20/15

15th of the month following credentialing approval

Example: Effective date 9/15/15

Medical group agreements (MGA) (Existing providers joining MGA)

Notification of joining MGA received between the 1st and 15th of the month

Example: MGA notification received 8/05/15

1st of the month following notification of joining MGA

Example: Effective date 9/01/15

Notification of joining MGA received between the 16th and end of the month

Example: MGA notification received 8/20/15

15th of the month following notification of joining MGA

Example: Effective date 9/15/15

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 8/5/15 and an effective date of 8/10/15

Date provided by delegate

  • Date of delegates credentialing committee approval, or
  • Effective date with delegate (whichever is later)

Example: Effective date 8/10/15

Non-standard agreements

New non-standard provider agreement:
After credentialing is approved and complete, the effective date of a provider agreement for a new provider will be the 1st or the 15th of the following month, unless noted in table above.

Non-standard provider agreement renewals
Existing provider agreements in which only payment terms are revised or extended, will be limited to an effective date of the 1st or the 15th of the month, whichever date provides at least ten (10) business days prior to the effective date of the new provider agreement terms.

Participating Dental Agreements

We use a single Dental Group Agreement for multiple providers using a Federal tax identification (ID) number. This agreement covers all providers doing business under that tax ID number. Providers using their Social Security Number (SSN) will receive an Individual Dental Provider Agreement.

Benefits of participation

  • You may provide input on our policies.
  • Claim payments are made to you directly on a weekly basis.
  • Provider representatives, provider consultants and dental relations representatives are 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.

Responsibilities of Participation

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.
  • 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.

Keep your practice information current

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. Please contact your provider relations representative to let us know about any of the following changes:

  • Closing a practice
  • Changing organization ownership
  • Terminating a network affiliation for any reason

You can complete a Provider Information Update Form for any of the following changes:

  • Specialty
  • Phone number
  • Organization's address
  • Accepting new patients
  • eContracting email address
  • Request a roster for validation
  • 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)
  • Organization's address (if this change does not require you to contact us as indicated above)
    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.

Validating provider directory content

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.

Reimbursement schedules

Provider reimbursement schedules and other pricing documents are available after logging into the Availity Provider Portal.