When UMP Classic/UMP CDHP is your primary insurance and your provider is preferred, you don't need to submit claims; the provider will do it for you. If you have a question about whether your provider's office has submitted a claim, check your regence.com account or call Customer Service at 1-888-849-3681.
When Do I Need to Submit a Claim?
You may need to submit a claim to UMP Classic/UMP CDHP for payment if you receive services from an out-of-network provider or if you have other insurance that pays first and UMP Classic/UMP CDHP is secondary. Note: Medicare enrollees, see pages 66-71 in the 2014 UMP Classic Certificate of Coverage, or page 60 of the 2014 UMP CDHP Certificate of Coverage.
If you get a vaccine (including a flu shot) from an out-of-network provider, you must submit the claim to Regence as a medical claim.
Out-of-network providers may submit a claim on your behalf; ask the provider.
How Do I Submit a Claim?
TIP: If you purchase contact lenses or eyeglasses from an out-of-network provider that doesn't bill your plan, you will need to submit a claim for reimbursement. You can download the Vision Claim Form or call Customer Service for a copy.
To submit a claim yourself, you'll need to obtain and mail the following documents:
1. The Medical Claim Form—You can find the form here, or you may request a form by calling Customer Service at 1-888-849-3681.
2. An itemized bill from your provider that describes the services you received and the charges.
The following information must appear on the provider's itemized bill for the plan to consider the claim for payment:
- Patient's name and plan ID number, including the alpha prefix (three letters before ID number).
- Description of the injury or illness.
- Date and type of service.
- Provider's name, address, and phone number.
- For ambulance claims, please also include where the patient was picked up and where he or she was taken.
3. If UMP Classic/UMP CDHP is secondary, you must include a copy of your primary plan's Explanation of Benefits, which lists the services covered and how much the other plan paid. You should wait until the primary plan has paid to submit a secondary claim to UMP Classic/UMP CDHP, unless the primary plan's processing of the claim is delayed. Claims not submitted to UMP Classic/UMP CDHP within 12 months of the date of service will not be paid.
Please note that if we have to request additional information, this may delay the processing of your claim.
Reimbursement for services received from an out-of-network provider may be sent to the provider or to you in the form of a check listing both you and the provider as payees.
Be sure to make copies of your documents for your records.
Mail both the claim form and the provider's claim document (or bill) to:
PO Box 30271
Salt Lake City, UT 84130-0271
Call Customer Service at 1-888-849-3681 if you have a question about the processing of your claim.
Important Information About Submitting Claims
ALERT! You or your provider must submit claims within 12 months of the date you received health care services; this is called the "timely filing" deadline. The plan will not pay claims submitted more than 12 months after the date of service.
For more information about submitting claims for services outside of the United States, see "How do UMP Classic and UMP CDHP cover services outside of the United States?"
If you or a family member has other health care coverage, see the "If You Have Other Medical Coverage" in your Certificate of Coverage for information on how the plan coordinates benefits with other plans.
Most of the time, the plan will pay preferred providers directly. For claims submitted by you or an out-of-network provider, the plan will determine whether to pay you, the provider, or both you and the provider. For a child covered by a legal qualified medical child support order (QMCSO), the plan may pay the custodial parent or legal guardian of the child.
You will be notified of action taken on a claim within 30 days of the plan receiving it. This 30-day period may be extended by 15 days when action cannot be taken on the claim due to:
- Circumstances beyond the plan's control. Notification will include an explanation why an extension is necessary and when the plan expects to take action on the claim.
- Lack of information. The plan will notify you within the 30-day period that an extension is necessary, with a description of the information needed as well as why it is needed.
If the plan is asking you for additional information, you will be allowed at least 45 days to provide it. If the plan doesn't receive the information requested within the time allowed, the claim will be denied.