Provider appeals

In situations where a Regence provider is at financial risk for the cost of the claim, the Regence Adverse Determination Appeal Process is followed.

Member appeals

• If the member is financially responsible (e.g., the claim is denied for medical necessity by the member's Blue Plan), the member should submit the appeal to their Blue Plan.
• If you submit an appeal on behalf of a member, you need to submit pertinent medical records or other supporting documentation with the claim appeal request to help expedite the appeal review process. In addition, some states require a signed specialized member authorization form. View the list of member authorization requirements by Blue Plan. You can send the information to our correspondence address (attention: BlueCard). We will contact the member's Blue Plan on your behalf.

View BlueCard Program resources and tools.