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.
• We require all onboarding tasks, including registration for Availity Essentials and enrollment for electronic funds transfer (EFT) be completed before agreements are issued.

Complete an application to join our dental networks and complete the onboarding process at regencedental.com.

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.

• 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). Behavioral health and palliative care services are exceptions 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.

Follow these steps to update your directory information.

We require that you review your directory information to verify accuracy and submit all updated information about your practice at least every 90 days. View our Provider Directory Attestation Requirements for Providers policy and steps for validating your directory information.

Provider reimbursement schedules and other pricing documents are available to contracted providers after logging into Availity Essentials: Claims & Payments>Fee Schedule Listing.