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December 12, 2023

One way Regence helps ensure members receive appropriate care while in an inpatient or continued-stay care setting is through concurrent review. Our Clinical Services team reviews members’ medical records to determine whether the care they’re prescribed meets their specific medical or behavioral needs and will be delivered at the appropriate site of care.

Effective Feb. 1, 2024, for all members in all lines of business, we will begin enforcing the requirement that medical records supporting inpatient and continued stay admissions be submitted to us by the provider by the day they’re requested. Upon receiving notification of a member’s admission, which is also required, we'll fax an admission acknowledgement to the provider that includes the date we require them to submit updated medical records to us.

Records requested include medical records, labs, medications, diagnosis, progress notes and physician orders. They may also include imaging, therapy notes, and case management and discharge planning. Requests for concurrent medical necessity review must include diagnosis and clinical information regarding the member’s current admission.

Admission notification or requested records that are not submitted by the required date or are incomplete may result in administrative denial of coverage of all or part of the admission and treatment.

We've notified providers about this requirement in our provider newsletter, The Connection, and updated our affected pre-authorization lists.

Questions? Please contact your account representative.