Regence Blue Cross Blue Shield
Oregon/Idaho/Utah/Washington • Medicare Advantage, POS, High-Deductible Health Plan (HDHP)
Medicare Advantage coverage under this prefix means the plan administers Medicare Part A and Part B benefits on behalf of CMS. These claims may have different processing rules than commercial claims, including different prior authorization requirements and appeal timelines. CMS timely filing rules (365 days) typically apply.
This is a Point of Service (POS) prefix. POS plans offer flexibility similar to a PPO but incentivize in-network care through lower cost-sharing. Members designate a primary care physician who can issue referrals for the highest level of benefits. Out-of-network claims are covered but at significantly reduced rates.
HDHP coverage under this prefix means the member carries a higher annual deductible in exchange for lower monthly premiums. Claims are processed normally but the member's cost-sharing will be higher than standard plans until the deductible is met. Preventive services are typically the exception and are covered at no cost to the member.
Regence Group Administrators providing plans across Oregon, Idaho, Utah and Washington regions with commercial, Medicare and Medicaid options.