BlueCard® is a national program that enables members of a Blue Cross and/or Blue Shield Plan (Blue Plan) to obtain health care services while traveling or living in another Blue Plan's service area. Regence is part of the BlueCard national program.
We believe that sharing cost and quality data with our members helps them make more-informed health care decisions. Our cost and quality programs include community collaboratives, cost estimator, patient reviews and our Quality Program.
Our medical management programs are either targeted to specific conditions or designed to improve or maintain overall health. Programs include case management, diabetes and disease management, Personalized Care Support (palliative care), radiology, and physical and sleep medicine.
Pharmacy Services assists our providers and members with prescription benefits and other relevant information. Learn more about special member programs, pharmacy prior authorization, Preferred Medication List / Formulary information.
This program is designed to reward providers who ensure that identified medical care or diagnosis gaps for Medicare Advantage patients are addressed and closed each year. Learn about member gap reports, calculating incentives and receiving payment.
The Centers for Medicare & Medicaid Services (CMS) assigns Medicare Advantage plans with a quality rating on an annual basis using a five star rating system. Learn how you can influence star ratings.
Risk adjustment is designed to encourage insurers to compete on quality and efficiency, preserve consumer choice and improve quality of care for patients. Risk scores for members are calculated differently for Medicare and commercial members, but the information required from providers and office staff is the same.