1. Before requesting pre-authorization, please verify eligibility and benefits via Asuris Online Services for Providers.
2. Verification of member eligibility is valid if obtained within five business days of service except in the case of misrepresentation.
3. Pre-authorizations obtained within 30 business days prior to service are valid except in the case of misrepresentation.
4. Medical policies related to specific pre-authorization requirements are available online at http://blue.regence.com/trgmedpol/index.html.
5. Potentially investigational services may also be considered medically necessary for select diagnoses. Please refer to the Asuris Clinical Edits by Code list for additional information. Unlisted codes may be used for potentially investigational services and are subject to review. 
6. Some member contracts have specific pre-authorization requirements. The member's contract language will apply.
7. Urgent/Emergent services do not require pre-authorization.
8. Pharmacy prior authorization information and forms can be found at the RegenceRx Physician Web site.

Please note that courtesy pre-authorization for Boeing members is performed out-of-state.

• Inpatient/partial/residential admissions require notification. Concurrent review will occur after eight days.
• Outpatient - Concurrent review will occur after 30 visits.

Boeing Helpline Phone: 1 (800) 892-1411

20974, 20975, E0747, E0748, E0749

View the Medical Policy at http://blue.regence.com/trgmedpol/dme/dme10.html

A9276, A9277, A9278, S1030, S1031

View the Medical Policy at http://blue.regence.com/trgmedpol/dme/dme77.html

E1002, E1007, E1220, K0005, K0011, K0014, K0823, K0856

View the Medical Policy at http://blue.regence.com/trgmedpol/dme/dme37.html

Please refer to the Asuris Clinical Edits by Code list for additional DME code information.

Transplants, ventricular assist devices and total artificial hearts (pre-authorization not required for corneal and kidney transplants)

Transplants
G0341, G0342, G0343, S2053, S2054, S2055, S2060, S2065, S2150, S2152, 32851, 32852, 32853, 32854, 33935, 33945, 38205, 38206, 38230, 38240, 38241, 44135, 47135, 47136, 48160, 48554, 0141T, 0142T, 0143T

Ventricular assist devices and total artificial hearts
33975, 33976, 33979, 0048T, 0050T, 0051T

All hospital admissions require notification

Concurrent review will occur after 7 days.

Long Term Acute Care Facility (LTAC)

Rehabilitation

Skilled Nursing Facility (SNF)

Obesity surgery

43644, 43770, 43771, 43772, 43773, 43774, 43846, 43848, 43886, 43887, 43888

View the Medical Policy at http://blue.regence.com/trgmedpol/surgery/sur58.html

Orthognathic surgery

21120, 21121, 21123, 21125, 21127, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21230 

View the Medical Policy at http://blue.regence.com/trgmedpol/surgery/sur137.html

Sleep apnea surgery

Please refer to the Asuris Clinical Edits by Code list for potentially investigational procedures.

Potentially cosmetic procedures to restore or improve appearance that may also correct a functional impairment

Pre-authorization not required for initial breast reconstruction one or two stages and nipple/areola reconstruction following mastectomy.

Please refer to the Asuris Clinical Edits by Codelist for cosmetic and potentially cosmetic procedures.

Potentially investigational services that are considered investigational, but for select diagnoses, may also be considered medically necessary.

May not be covered under the member's contract. However, pre-authorization is recommended for any policy that has specific medical necessity criteria in addition to the experimental and investigational language.

Unlisted codes may be used for potentially investigational services and are subject  to review. 

Please refer to the Asuris Clinical Edits by Code list for additional information.