Submit a Preauthorization Request Need help with a claim? Regence users: make the switch to the Availity Web Portal You have been redirected from the Regence or Asuris Northwest Health Provider Center. Learn more about billing and how to submit claims to us for payment, including claims for BlueCross and BlueShield Federal Employee Program (BCBS FEP) members. Your trust is our top concern, so businesses can't pay to alter or remove their reviews. You have the right to make a complaint if we ask you to leave our plan. Premera Blue Cross Blue Shield of Alaska - FEP PO Box 33932 Seattle, WA 98133-0932 Phone: 800-562-1011 6:00 AM - 5:00 PM AST Fax: 877-239-3390 (Claims and Customer Service) Fax: 877-202-3149 (Member Appeals only) Fax: 866-948-8823 (FEP Care Management - prior auth/pre-service requests) Email Members: Log in or register - MyBlue Customer eService All claims must be submitted to UMP within 12 months of the date of service or purchase to prevent denial of the claim. Complete and mail or fax a Multiple Coverage Inquiry Form to Regence: Regence BlueShieldAttn: UMP ClaimsPO Box 91015MS BU386Seattle, WA 98111-9115. All features have been transitioned to the Availity Provider Portal. When a claim for workers compensation is accepted, all services related to that injury or illness are not covered, even if some services are denied by workers compensation. PO Box 91102Seattle, WA 98111-9202. Download a form to use to appeal by email, mail or fax. There are three levels to the appeals process: first-level, second-level, and external review (independent review). For information on false claims, see False claims or statements in your certificate of coverage. In addition, you cannot obtain a brand-name drug for the copayment that applies to the generic drug. Attn: Member Appeals The quality of care you received from a provider or facility. If you have . PO Box 52080 Send your claim or correspondence to the Blue Cross Blue Shield plan in the state where the laboratory work was sent for testing.Example: The lab service you used is in Arizona but the sample was sent to Nevada for analysis. Coordination of Benefits, Medicare crossover and other party liability or subrogation. See what were doing in your community to keep people safe and healthy. Click on your plan, then choose theGrievances & appealscategory on the forms and documents page. We're ready. Learn how our innovative solutions can help your employees live healthier, while helping you manage your costs. Member's name and member ID number, including the alpha prefix (three letters and the "W" before member ID number), b. treatment center. TTY/TDD users can call 1-877-486-2048, 24 hours a day/7 days a week. TTY users should call, 1-800-325-0778; or your Medicaid Office. 2003 Western Ave # 600, Information current and approximate as of December 31, 2018. The member can appeal, or a representative the member chooses, including an attorney or, in some cases, a doctor. Requests to find out if a medical service or procedure is covered. Prescription questions?Call Customer Service and choose the Pharmacy option. Regence BlueCross BlueShield of Oregon, headquartered in Portland, has been serving Oregonians since 1941 and now provides more than 974,000 people with comprehensive health insurance solutions. A complaint or grievance is an oral statement or written document submitted by or on behalf of a member regarding: Note: If your issue is regarding a denial, reduction, or termination of payment or non-provision of medical services, it is an appeal. Step 1: Start your internet browser, and then go to the official regence bluecross blueshield of oregon claims address website. Consult theFEP local plan directory to find addresses and telephone numbers for other plans.Note: If the equipment was sent from a DME provider in Washington, refer to thesubmission map to determine where to send your claim for processing. 2023 Regence BlueShield. Blue Cross and Blue Shield of Montana will process the claim. 3 0 obj No enrollment needed, submitters will receive this transaction automatically, Web portal only: Referral request, referral inquiry and pre-authorization request, Implementation Acknowledgement for Health Care Insurance. Don't have your card? Waiting too long on the phone, waiting room, in the exam room or when getting a prescription, The length of time required to fill a prescription or the accuracy of filling a prescription, Access to health care benefits, including a pre-authorization request denial, Claims payment, handling or reimbursement for health care services, A person who has bought insurance for themselves (also called a contract holder) and any dependents they choose to enroll. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. Learn more about global periods, modifiers, virtual care, unlisted codes and NCCI bypass modifiers. Notice will include explanation why an extension is needed and when the plan expects to act on the claim. Pre-authorization View services and supplies that require pre-authorization. But there are some circumstances where you will need to submit a claim. Find helpful phone, fax and email information for assistance. If you have questions, contact Washington State Rx Services Customer Service at 1 (888) 361-1611 (TRS: 711) Monday through Friday 7:30 a.m. to 5:30 p.m. (Pacific). You must submit first-level and second-level appeals no more than 180 days after receiving the previous decision. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. I . Instructions: 1. See "Appeals related to eligibility" section of your plan's. An appeal qualifies for the expedited process when the member or physician feels that the member's life or health would be jeopardized by not having an appeal decision within 72 hours. Email: Send email through your WSRxS account at ump.regence.com/sebb/benefits/prescriptionsNote: This email is not secure. Ting Vit | Why choose Regence Individual & family plans Blue cross blue shield address Medicaid Address and phone number - List 1 Medicaid claim submission address - List 2 Medicare . endobj Call UMP Customer Service for help with any questions when you or a family member is covered by more than one plan. Visit the Regence provider website, regence.com to learn more about: Contact Us View information about who to contact for questions and issues. Recommended Reviews. Washington State Rx ServicesPO Box 40168Portland, OR 97240-0168. Box 30805 Salt Lake City, UT 84130- 0805 *Pennsylvania BCNEPA P.O. We will notify you if we need more time to respond. In the left-hand column, locate the state where services were rendered. Step 4: After you have completed the login details correctly . Management - prior auth/pre-service requests), Members: Log in or register - MyBlue Customer eService, Retail Pharmacy Program PO Box 52057 Phoenix, AZ 85072, Retail Pharmacy Program PO Box 52080 Phoenix, AZ 85072, Phone:800-552-0733Fax: 801-333-6523 (Mark claims: Attn New Claims)Email: Log in or register - MyBlue Customer eService, Regence BlueShield - FEPPO Box 857Lewiston, ID 83501, Regence BlueShield - FEPPO Box 1388Lewiston, ID 83501Customer Service. Regence BlueCross BlueShield of Utah offers health and dental coverage to 528,000 members throughout the state. You have the right to appeal, or request an independent review of, any action we take or decision we make about your coverage, benefits or services. You can also download the appeal form and submit your written appeal by email, fax, or mail:Email: UMPMemberAppeals@regence.comFax: 1 (877) 663-7526, Mail:UMP Appeals and GrievancesRegence BlueShieldPO Box 91015Seattle, WA 98111-9115. You receive services from an out-of-network provider. Many issues may be resolved with a phone call. You can submit feedback about your Medicare health plan or prescription drug plan directly to Medicare. Learn about electronic funds transfer, remittance advice and claim attachments. stream Note:TovieworprintaPDFdocument,youneed AdobeReader. Dental billing. If you do not obtain your physician's support, we will decide if your health condition requires a fast decision. Procedure and diagnosis (codes) or description of the injury or illness, d. Provider's name, address, phone number, and National Provider Identifier (NPI) or Tax ID number, e. For ambulance claims, also include the ZIP code where the member was picked up and where they were taken. The plan will not pay claims for prescription drugs submitted more than 12 months after purchase or prescription drugs purchased from an excluded pharmacy. Out-of-network providers may submit a claim on your behalf. Regence BlueCross BlueShield of Oregon is an independent licensee of the Blue Cross and Blue Shield Association. for other plans. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) You can send your appeal online today through DocuSign. The following information must appear on the provider's itemized bill for the plan to consider the claim for payment: a. Is this your business? When the plan is the primary payer (pays first), UMP pays its normal benefit as described in the certificate of coverage. People with a hearing or speech disability can contact us using TTY: 711. See reviews, salaries & interviews from Regence employees in Lewiston, ID. Learn about dental billing information to help ensure your dental claims are processed quickly and correctly. Location. FAQs & Resources 2 0 obj This form is to be used to request a deduction on a future remittance advice (voucher) in response to a recent recoupment request from Regence, or as a result of an overpayment discovered by your internal claims review process. For services outside this area, please contact customer service directly at 1 (800) 365-3155 as your claim will require special handling. | Your provider must submit all clinically relevant information to the plan by phone or fax. Consult theFEP local plan directory to find addresses and telephone numbers for other plans.Note: If the laboratory work was sent to Washington for testing or analysis, refer to theWashington claims submission map to determine where to send your claim for processing. the instructions to determine where to send claims or correspondence. To request or check the status of a redetermination (appeal). We are now processing credentialing applications submitted on or before March 6, 2023. Box 1106Lewiston, ID 83501-1106 Fax: 1 (877) 357-3418 If you have questions about submitting a claim for services outside the U.S., call UMP Customer Service. For more information about authorizing a representative to request an appeal for you, read the Confidentiality of your health information section of your plans certificate of coverage. Were proud to stand with you during this challenging time. For more specific contact information, choose from the following: Individuals and families Medicare Employers Producers Providers Fraud or abuse You can remain anonymous. You must submit prescription drug claims within 12 months of purchase. Regence BlueShield. For any appeals that are denied, we will forward the case file to MAXIMUS Federal Services for an automatic second review. Claims & payment Claims & payment Learn how to identify our members' coverage, easily submit claims and receive payment for services and supplies. Box 999Appleton, WI 54912-0999Fax: 1 (855) 668-8550. The ambulance claim will be processed by Blue Cross Blue Shield of Oregon. Members: Log in/register at MyBlue Customer eService, Regence Blue Cross Blue Shield of Oregon - FEPPO Box 31105Salt Lake City, UT 84131, Regence Blue Cross Blue Shield of Oregon - FEPPO Box 1269Portland, OR 97207. To appeal by phone or if you have questions, contact UMP Customer Service at 1 (800) 628-3481 (TRS: 711) Monday through Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. (Pacific). Address: 200 SW Market St Portland, OR, 97201-5715 United States See other locations Phone: Website: www.regence.com Employees (this site): Actual Employees (all sites): Actual Revenue: Modelled Year Started: Incorporated: ESG ranking: ESG industry average: What is D&B's ESG Ranking? 2. Appeal form (PDF): Use this form to make your written appeal. Regence BlueCross BlueShield of Utah Quickly identify members and the type of coverage they have. Find the right fit for your next chapter with top-rated coverage and care you can trust. The plan must receive all relevant information with the appeal to make sure the most accurate decision is made. Be sure to include any other information you want considered in the appeal. Join us! Contact informationMedicare Advantage/Medicare Part D Appeals and GrievancesPO Box 1827, MS B32AGMedford, OR 97501, FAX_Medicare_Appeals_and_Grievances@regence.com, Oral coverage decision requests1 (855) 522-8896, To request or check the status of a redetermination (appeal): 1 (866) 749-0355, Fax numbersAppeals and grievances: 1 (888) 309-8784Prescription coverage decisions: 1 (888) 335-3016. For more information about the appeals process, including expedited appeals for urgent or life-threatening conditions and requesting an external review by an Independent Review Organization, read the "Complaint and appeal procedures" section in your plan's certificate of coverage. See Occupational injury or illness (workers' compensation) claims in your certificate of coverage. Cancel Proceed User name or email Youll receive notice of the action on your complaint within 30 calendar days of our receiving it. Asthma. Please note: This form is to be used by physicians, other professional providers or medical facilities to contact their assigned provider relations representatives. Appropriate staff members who were not involved in the earlier decision will review the appeal. Though it is not required, you may want to include the UMP Appeals and Grievance form (for medical services) or the Washington State Rx Services Complaint and Appeal Form (for prescription drugs) with your appeal. Regence BlueCross BlueShield of Oregon. Lastly mail the completed claim form to the address provided. When UMP pays second to another plan that covers the member, UMP will pay only an amount needed to bring the total benefit up to the amount UMP would have paid if the member did not have another plan. UMP medical plans are administered by Regence BlueShield. If your prescribing physician asks for a faster decision for you, or supports you in asking for one by stating (in writing or through a phone call to us) that he or she agrees that waiting 72 hours could seriously harm your life, health or ability to regain maximum function, we will give you a decision within 24 hours. Uniform Medical Plan (UMP) is a self-insured Preferred Provider Organization (PPO) medical plan offered through the Washington State Health Care Authority. <>>> For the Health of America. Get help when you need it. If the decision was after the 60-day timeframe, please include the reason you delayed filing the appeal. Mail or fax both the claim form and the provider's claim document (or bill) to: Regence BlueShield Attn: UMP Claims P.O. As one of the state's largest health insurers, Regence BlueCross BlueShield of Oregon is committed to addressing current and emerging health needs for the nearly one million Oregonians we serve. For questions about appeals, call the SEBB Appeals Unit at 1 (800) 351-6827. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> If your primary plan uses a different mail-order pharmacy, you will have to use your primary plans mail order pharmacy and then submit a claim to Washington State Rx Services. %&xv}`kfg`O>=toy,y_bI)45T\ei@{65z9|i8NhI;nTSp~b5[iN_ pn+JsX;fz|4]R 8ZTJ.#fdP]^RP|z~-3KT\n:)O68m+zm96th+/5O6=%7;s"(CTF fZTreF`Tzq`a=6>GGW[tXudM+W6`m~yuCCu xd!XDmSdoQ/= y?ck r1rMc.c0>'1|\a{ enTc |GBl]|mCxr,. complies with applicable Federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation. Seattle, WA 98121, Support Phone Number: 1.888.427.0470 (toll free), Mon-Fri, 7:00 a.m. to 5:00 p.m. (PT), 1.800.AVAILITY (1.800.282.4548) (toll free), Run transactions to obtain member benefit, eligibility and claims information, Access eContracting to view and sign agreement documents, Our online newsletter (6 issues per year). Don't have a Regence account yet? Learn how to identify our members coverage, easily submit claims and receive payment for services and supplies. Select the area of the map that matches the color of the county where the service was performed. If you or your dependents are enrolled in UMP High Deductible and want to enroll in another health plan, you and your dependents can only enroll in other high-deductible health plans. You must submit the claim to Regence as a medical claim. Congestive Heart Failure. Library Access our Administrative Manual and keep up to date with news. When you use a network provider or network pharmacy, you dont need to submit a claimthe provider or pharmacy will do it for you. | For more information about dual coverage, read the If you have other medical coverage (or UMP High Deductible "If you have other HDHP coverage") section in your plans certificate of coverage. In every state and every community, BCBS companies are making a difference not just for our members, but For the Health of America. You must continue to use network pharmacies until you are disenrolled from our plan to receive prescription drug coverage under our formulary. endobj MAXIMUS will review the file and ensure that our decision is accurate. ** We respond to medical coverage requests within 14 days for standard requests and 72 hours for expedited requests. Regence BlueShield of Idaho offers health and dental coverage to 142,000 members throughout the state. If you wish to appoint someone to act on your behalf, you must complete an appointment of representative form and send it to us with your prescription coverage determination form. 636 GRAND AVE DES MOINES, IA 50309 800-245-6105. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. You will also receive a decision on your appeal within 30 calendar days. Complete and mail or fax a WSRxS Multiple Pharmacy Coverage Inquiry Form (Drug Coordination of Benefits) to Washington State Rx Services. You can also call Washington State Rx Services with the information at 1 (888) 361-1611 (TRS: 711). Send to Regence Blue Shield in accordance with the terms of your provider contract with Regence. If MAXIMUS disagrees with our decision, we authorize or pay for the requested services within the timeframe outlined by MAXIMUS. Stay up to date on what's happening from Salt Lake to St. George. If requested, we will supply copies of the relevant records we used to make our initial decision or appeal decision for free. Portugus | Your life. Send your claim or correspondence to the Blue Cross Blue Shield plan in the state where the ambulance picked up the patient.Example: An ambulance picks up the patient in Oregon and transports her to a care facility in Washington. For member appeals that qualify for a faster decision, there is an expedited appeal process. Please follow Regence Blue Shield in accordance with the terms of your provider contract with Regence. See the About UMP High Deductible Health Plan and If you have other HDHP coverage sections in the UMP High Deductible certificate of coverage for more information on secondary health plans and limitations. Follow the prompts to submit your claim online. If you have any questions about specific aspects of this information or need clarifications, please email press@bcbsa.com . Dissatisfaction with service provided by the health plan. You must appeal within 60 days of getting our written decision. Box 995 Birmingham, AL 35298 Arkansas Arkansas BCBS PO Box 2181 Little Rock AR 72203 -2181 Arizona BCBS of Arizona . Please include the following information when requesting an appeal: The plan will send confirmation when it receives your appeal. Other specialized services (home hospice, organ/tissue transplants, and clinical trials). Learn more about informational, preventive services and functional modifiers. You can submit a marketing complaint to us by calling the phone number on the back of your member ID card or by calling 1-800-MEDICARE (1-800-633-4227). Chronic Obstructive Pulmonary Disease. It was formed in 1982 from the merger of its two namesake organizations: Blue Cross was founded in 1929 and became the Blue Cross Association in 1960, while . Username. I had an out-of-network claim for my disabled husband and they rejected it as "out of network".