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Uniform Medical Plan (UMP) is a preferred provider health plan managed by the Washington State Health Care Authority (HCA) through the Public Employees Benefits Board (PEBB). The plan serves state and public employees, retirees and their dependents. HCA signed a four-year contract naming Regence BlueShield the new administrative services provider for UMP beginning January 1, 2011.
Important UMP billing information
When submitting claims for your Uniform Medical Plan (UMP) patients, please include the three letter alpha prefix and the member number displayed in the ID NO field on the member card. The member number begins with a “W” followed by nine numbers.
If you use the Provider Center to verify eligibility for UMP members, enter only the nine digit member number. Do not include the alpha prefix or the “W” preceding the numbers.
UMP members do not have dental insurance through Regence. Please check the member’s dental coverage and submit the claim to the appropriate dental plan.
Important change to the UMP specialty drug provider (4/1/2012)
Effective April 1, 2012, BioScrip will no longer provide specialty drug pharmacy services for Uniform Medical Plan Classic (UMP Classic) and UMP Consumer-Directed Health Plan (UMP CDHP) members only. Beginning April 1, Diplomat Specialty Pharmacy (Diplomat) will provide services for specialty drugs. Diplomat will contact members, prior to April 1, who have a current specialty prescription and assist them with this transition. Providers may also contact Diplomat at 1 (877) 203-8602 (Monday-Friday 5am to 8pm and Saturday 6am to 2pm)
Please note that all specialty drugs must come from Diplomat beginning April 1. The plan does not cover specialty drugs from any other pharmacy. However, if this transition may cause a delay for your patient in getting their specialty medication(s), call 1 (888) 361-1611 to request a one-time fill at a retail pharmacy.
Learn about UMP
Provider Network
UMP will use the Regence Preferred Provider Organization (PPO) network, giving UMP members access to Regence providers and the broader Blue Cross and/or Blue Shield networks outside of the Regence service area in Washington and throughout the United States.
Customer Service
Members and providers will have access to a designated Regence UMP customer service team Monday through Friday from 7 a.m. to 5 p.m. PST:
- Providers may call 1 (888) 849-3682.
- Members may call 1 (888) 849-3681.
Pre-authorization
UMP Pre-authorization List
UMP has unique pre-authorization requirements. To pre-authorize services and procedures please fax 1 (877) 663-7526 or call Customer Service 1 (888) 849-3682 for more information.
The required pre-authorization is listed below:
Health Technology Assessments
HTA determines if health services used by state government are safe and effective. UMP benefits are subject to “Findings and Decisions," which may impact pre-authorization requirements.
United Medical Resources and Aetna pre-authorizations
If you received a pre-authorization from either United Medical Resources (UMR) or Aetna for a UMP member for a service to be rendered in 2011, please submit the pre-authorization to Regence via fax at 1 (877) 663-7526 or upon submission of your claim for the service. If the service that was authorized by the prior carrier does not have any pre-authorization requirements with Regence, there is no need to submit this information.
Coding Toolkit
Supplemental Clinical Edits by Code list
The Regence Clinical Edits by Code list applies to UMP members, however additional edits specific to UMP members are available on the Supplemental Clinical Edits by Code List. The UMP supplemental list is incorporated into the Regence Clinical Edits by Code list.
Concurrent Review
Inpatient Admissions (excluding Mental Health)
All hospital admissions require notification. Concurrent review will occur after 7 days. Pre-authorization is required prior to member admission for the following inpatient admissions:
- Long Term Acute Care Facility (LTAC)
- Rehabilitation
- Skilled Nursing Facility (SNF)
View the UMP pre-authorization list
Mental Health
Concurrent review of mental health treatment is conducted when outpatient visits reach 20 (combined) visits or an inpatient stay exceeds two days. Consideration of additional treatment occurs when the provider submits a treatment plan for clinical review.
If we receive a claim that exceeds the guideline for review (20 visits for outpatient treatment or two days for inpatient treatment) and it does not have an authorization, claims processing will be suspended for up to 45 days while we contact the provider to obtain documentation for review and authorization. Once we receive documentation for review, we will make a determination and claims processing will resume.
If documentation is not received after 45 days, claims will be processed without any benefits paid and the member’s explanation of benefits will advise that additional information is required.
