BCBS AFFILIATEOR, WA, ID, UTPBM: Express Scripts
Regence BlueCross BlueShield (OR, WA, ID, UT) Prior Authorization Guide
Submit prior authorization requests and appeal denials with Regence BCBS. Phone numbers, fax numbers, appeal deadlines, step therapy override rights, and clinical documentation tips for OR, WA, ID, UT providers.
Prior Authorization Contacts
PA PHONE
1-800-638-0449
PA FAX
1-844-865-6730
TURNAROUND
14 days standard, 72h expedited
TIMELY FILING
365 days
APPEALS MAILING ADDRESS
Regence BCBS, Attn: Appeals, PO Box 1271, Portland, OR 97207
Common Denial Reasons
- ⚠ Regence Medical Policy criteria not met
- ⚠ Step therapy required
- ⚠ Non-preferred formulary
- ⚠ Site of care
Step Therapy Requirements & Override Rights
Regence serves OR, WA (parts), ID, and UT. Oregon HB 2517 (2019) provides step therapy override rights. Utah HB 133 (2019) similar. For biologics, typically requires 3-month conventional DMARD trial.
Tips for Regence BCBS Submissions
- 1. Regence covers OR, parts of WA, ID, and UT
- 2. OR HB 2517 and UT HB 133 provide step therapy override rights
- 3. Submit via Availity
- 4. Express Scripts is the PBM
External Review Authority
If Regence BCBS denies your final internal appeal, you have the right to request an external review through: Oregon DCBS / Washington OIC / Idaho Department of Insurance / Utah Insurance Department.
External review decisions are binding on the insurer.