Submit secondary claims promptly All health plans have a “timely submitting” deadline. The timely submitting deadline for UMP is 12 months from the date of service. If a claim is not submitted within the plan’s timely submitting deadline, UMP will deny it. If your primary plan delays payment on a claim, you must still submit to UMP within the submitting deadline to prevent denial of the claim. UMP may try to contact your primary plan for their benefit payment information or may estimate it to provide timely processing of your secondary benefit. Adjustments may be made when the primary plan pays their portion of your claim. Notifying your providers of any change to your coverage will help avoid errors and delays in processing of claims (see the “Billing and payment: submitting a claim” section). How diabetes care supplies are covered when UMP pays second UMP covers diabetes care supplies under the prescription drug benefit. If you get your supplies from a pharmacy, ask if the pharmacy can bill both your primary plan and UMP. If your pharmacy does, you do not need to do anything further. If not, you will need to send a claim to WSRxS for secondary payment (see the “Submitting a claim for prescription drugs” section for instructions). If you get your supplies from a diabetes care supplier, the primary plan may process the claim as medical. In this case, you need to send your Explanation of Benefits and a claim form to WSRxS for secondary payment (see the “Submitting a claim for prescription drugs” and the “False claims or statements” sections for instructions). Note: Nonduplication of benefits applies to these claims, which means that UMP may pay nothing after your primary plan pays. See the “Diabetes care supplies” benefit for more information. ALERT! You must submit secondary claims for diabetes care supplies to WSRxS. Regence BlueShield will deny these claims. How COB works with prescription drugs Some of the limits and restrictions to prescription drug coverage listed in the “Limits on your prescription drug coverage” section will apply when UMP pays second to another plan. See the “Submitting a claim for prescription drugs” section for how to submit your prescription drug claim. Nonduplication of benefits applies when UMP pays second to another plan. This means that UMP may pay nothing after your primary plan pays. Using network pharmacies when UMP is secondary If you have primary coverage through another plan that covers prescription drugs, show both plan member ID cards to the pharmacy and make sure they know which plan pays first and which plan pays second. It is important that the pharmacy bills the plans in the correct order, or claims may be denied or paid incorrectly. Using mail-order pharmacies when UMP is secondary If your primary plan also uses one of UMP’s network mail-order pharmacies as the plan’s network mail- order pharmacy, UMP’s network mail-order pharmacies may process payments for both plans and charge you only the remainder. Make sure that UMP’s network mail-order pharmacies have the information for both plans and know which plan is primary. However, if your primary plan uses a different mail-order pharmacy, you will have to use your primary plan’s mail-order pharmacy, then submit a paper claim to UMP. See the “Submitting a claim for prescription drugs” section for how to do this. 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage 121