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  • 1. How do I submit an appeal or complaint regarding medical services or prescription drugs? Updated
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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. 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
  • 3. 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. 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. See also instructions for submit  More...
  • 4. What is an expedited appeal?
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    Expedited Appeals for Medical Service Claims Involving Urgent Care 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. This means that Regence will decide on your appeal within 72 hours of the request. Your provider  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. What can I do if UMP denies my pharmacy claim?
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    Call Washington State Rx Services at 1-888-361-1611 to find out why the claim was denied. If you disagree with the reason for the denial, you may request an appeal. For more information, read about our UMP Complaint and Appeal Procedures .
  • 8. Prescription Drug Contact Information
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    Washington State Rx Services 1-888-361-1611 7:30 am to 5:30 pm, Monday-Friday Network Mail-Order Pharmacy Faxing prescriptions to PPS (Postal Prescription Services) Note: Only a provider can fax a prescription. 1-800-552-6694 Fax 1-800-723-9023 (providers only) Mailing a prescription order Postal Prescription Services PO Box 2718 Portland, OR 97208-2718 Contact PPS for instructions Specialty pharmacy (Diplomat) (see Specialty drugs under UMP ) 1-877-203-8602 Fax 1-877-731-1122 (providers on  More...
  • 9. What is an "independent review"?
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    To qualify for an independent review, you must have already gone through both a first- and second-level appeal with the plan. If you have received a second-level appeal decision from the plan and do not agree with the result, you may request an independent review. NOTE: Not all issues are eligible for an independent review. To contact us about independent reviews, call: Medical (not prescription drugs) services: 1-888-849-3681 Prescription drugs: 1-888-361-1611 See How does the independent rev  More...
  • 10. UMP definition: "experimental or investigational" services
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    Experimental or investigational means a service, supply, or drug that the plan has classified as investigational. The plan will review scientific evidence from well-designed clinical studies found in peer-reviewed medical literature, if available, and information obtained from the treating provider regarding the service, supply, or drug to determine if it is investigational. A service, supply, or drug not meeting all of the following criteria is, in the plan's judgment, investigational: A me  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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