Medical management

Medical management

We provide a wide range of medical management programs designed to support our members at any stage of health. These programs are targeted to specific conditions or are designed to improve or maintain overall health.

The goals of our medical management programs are to:

  • Ensure our members receive appropriate care
  • Assist our members with managing a limited benefit
  • Enable us to be responsible stewards of the cost of health care

Dental care management

We apply appropriate dental care management procedures to ensure that treatment provided:

  • Is consistent with widely accepted standards of practice
  • Could not have been omitted without adversely affecting the patient's condition or quality of care
  • Is not primarily for the convenience of the patient, the participating dental provider or any other person
  • Is the least costly appropriate treatment and location that can be used safely to treat the patient's condition
  • Is the appropriate type, level, amount and frequency of care necessary to treat a dental condition or injury that is harmful to the health of a patient

Kidney health management

Healthmap Solutions is the approved vendor for our kidney health management program, which improves care and outcomes for eligible members with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The program focuses on early detection, proper care and treatment as the most effective approaches to delay the disease’s progression, enabling patients to live better, longer lives. It also enhances the physician-to-patient relationship because Healthmap supplies providers with actionable information to more effectively anticipate and deliver the right care at the right time and in the right setting.

Note: To ensure best practice and compliance with HIPAA, we have entered into a Business Associate Agreement with Healthmap. Healthmap may contact your office to request or share protected health information (PHI) about patients to facilitate these care coordination services and close care gaps. We have authorized Healthmap to do this, and these requests are permissible without patient authorization under HIPAA.

Physical medicine

We partner with eviCore Healthcare (eviCore) to manage our Physical Medicine program. Learn about all requirements.

Radiology

AIM Specialty Health administers the two components to our radiology program. Review the components.

Sleep medicine

We partner with AIM Specialty Health to manage our Sleep Medicine program. Review all the requirements.

Care management

Our case managers are an extension of the member's provider team and support each member in meeting their health care goals. Learn about Care management.

Peer-to-peer review

Learn how to request a conversation between a licensed Regence physician or clinical reviewer and the physician or other health care professional.

Personalized care support

Read about our palliative care program that focuses on supporting the health care needs of our members and their families at any stage of life or illness.