Billing and payment: submitting a claim Submitting a claim for medical services When UMP is your primary insurance and your provider is a network provider, you do not 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, sign in to your Regence account or contact UMP Customer Service (see Directory for link and contact information). See the “Submitting a Blue Cross Blue Shield Global® Core claim” section on page 28 for instructions on submitting a claim for services received outside of the United States. TIP: In the following section, Uniform Medical Plan (UMP) refers to the administrative functions for submitting claims to UMP. Regence BlueShield handles medical claims, and WSRxS handles prescription drugs claims. When you need to submit a claim You may need to submit a claim to UMP for payment if: • You receive services from an out-of-network provider. • You have other insurance that pays first and UMP is secondary. Out-of-network providers may submit a claim on your behalf. Ask your provider. How to submit a claim To submit a claim yourself, you may sign in to your Regence account and go to the Submit claim webpage at regence.com/member/submit-claim/ or you may complete a medical claim form and mail the following documents: • UMP (Regence) Medical Claim Form — You may find the form by visiting forms and publications at hca.wa.gov/ump-forms-pubs or you may request a form by contacting UMP Customer Service. • 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: • Member’s name and member ID number, including the alpha prefix (three letters and the ‘W’ before member ID number) • Procedure and diagnosis code(s) or description of the injury or illness • Date and type of service • Provider’s name, address, phone number, and National Provider Identifier (NPI) or Tax ID number • For ambulance claims, also include the ZIP code of where the member was picked up and where they were taken If UMP 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, unless the primary plan’s processing of the claim is delayed. Claims not submitted to UMP within 12 months of the date of service will not be paid. If we must request additional information, the processing of your claim may be delayed. Note: Be sure to make copies of your documents for your records. 122 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage