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  • 1. How do I submit an appeal or complaint regarding medical services or prescription drugs?
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    The following provides a brief overview of how you can appeal or complain to the plan. You can start with calling one of the phone numbers below. Many issues can be resolved this way. Customer Service for issues involving prescription drugs Washington State Rx Services 1-888-361-1611 Customer Service for issues not involving prescription drugs Uniform Medical Plan 1-888-849-3681 If you are not satisfied with the outcome of your phone call (you do not have to call before sending in a written appe  More...
  • 2. Forms available online: medical claim form, prescription drug forms, and some eligibility forms. Updated
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    NOTE: Due to requirements regarding secure transmission of confidential information, we cannot post forms that may be filled and submitted online. Looking for phone numbers? Medical Forms Medical Claim form (236K) Vision Claim Form (268K) (including eyeglasses and contacts) Coordination of Benefits (Multiple Coverage Inquiry Form) (247K) Incident Report Form (327K) (for accidental injuries) To obtain a Release of Information form, call 1-888-849-3681, or log in to your regence.com account. For a  More...
  • 3. How can I appeal issues relating to eligibility for coverage under UMP Classic and UMP CDHP?
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    Appeals related to eligibility and enrollment are handled by the Public Employees Benefits Board (PEBB) Program and governed by WAC chapter 182-16 . Information on how to file an appeal is available: On the PEBB website . By contacting the PEBB Appeals Manager at 1-800-351-6827 or by email at pebappeals@hca.wa.gov
  • 4. What is an expedited appeal? Updated
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    Expedited Appeals for Medical Service Claims Involving Urgent Care There are two parts to the expedited appeal process: first-level appeal and independent review. If the plan denies coverage for services and your provider determines that taking the usual time allowed could seriously affect your life, health, or ability to regain maximum function, or would subject you to severe pain that cannot be adequately managed without the care or treatment, ask your provider to request an expedited appeal.   More...
  • 5. If I disagree with what UMP covers, what should I do?
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    The Public Employees Benefits Board (PEBB) is responsible for designing benefits for UMP Classic and UMP CDHP. If you would like to contact PEBB about what is covered, or to learn more about the process, see Who decides what UMP Classic/UMP CDHP covers? How can I get involved in the process? . If you disagree with decisions relating to the processing of your claim, the availability of a health care service or coverage, authorization or provision of health care services, or benefits you feel have  More...
  • 6. How does the independent review process work?
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    What Is An Independent Review Organization? An Independent Review Organization (IRO) conducts the external review (also called an “independent review”). An IRO is a group of medical and benefit experts certified by the Washington State Department of Health and not related to the plan, Regence BlueShield, Washington State Rx Services, or the Health Care Authority. An IRO is intended to provide unbiased, independent clinical and benefit expertise as well as evidence-based decision maki  More...
  • 7. How to Designate an Authorized Representative
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    TIP: Because of privacy laws, the plan usually cannot share information on appeals or complaints with family members or other persons unless the patient is a minor, or the plan has received written authorization to release personal health information to the other person. If you want to authorize someone to receive your protected health information or designate a representative, you may request an Authorization to Disclose Protected Health Information form from Customer Service. This form must be  More...
  • 8. Initial Application for Bariatric Surgery Consideration
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    You can fill out this application online and click 'submit' OR download the paper form (123K) , print and mail it to: Attn: Appeals and Correspondence, M/S BU148 Regence BlueShield P.O. Box 2998 Tacoma, WA 98401-2998 Or by fax to: 1-877-663-7526 Please do not send any other paperwork or records at this time. If you cannot access the online or paper forms, contact UMP Customer Service at 1-888-849-3681.
  • 9. How preauthorization for medical services works
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    TIP: It is important to ensure that all needed information is sent to the plan. Sending insufficient information may lead to delays, or denial of services. See the list of services that require preauthorization. Your provider must submit a preauthorization request. The documentation needed depends on the service for which preauthorization is being requested. Providers may access plan medical policies online , or call Provider Services at 1-888-849-3682. Your provider will be notified that: The s  More...
  • 10. How long does the plan have to decide my appeal?
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    Time Limits for the Plan to Decide Appeals The time limits below apply to both first- and second-level appeals, and are calculated from when the plan receives the appeal. The plan will send written confirmation of your appeal to you within 72 hours of receiving it. The plan will decide on your appeal within 14 days of receipt but may take up to 30 days unless a different time limit applies as explained below. We will request written permission from you or your representative when we need an exte  More...

The certificate of coverage (COC) for the member's plan (UMP Classic or UMP CDHP) is the source of coverage provisions offered under the plans. If information given here is inconsistent with the applicable COC, the rules in the COC will apply. Also, the COC may have additional information on this subject.

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