contacting UMP Customer Service (medical appeals) or WSRxS Customer Service (prescription drug appeals). Regence BlueShield manages second-level appeals for medical services, and WSRxS manages second- level appeals for prescription drugs. Employees from Regence BlueShield and WSRxS reviewing the appeals will not have been involved in, or subordinate to anyone involved in, reviewing the first-level appeal or initial decision. If new or additional evidence or rationale is considered in reviewing your appeal, the plan will provide you with this information free of charge, and you may respond before the final decision. Expedited appeals process Expedited appeals for medical services You or your authorized representative may submit an expedited appeal within 180 days of receiving the previous decision if: • You are currently receiving or prescribed treatment or benefits that would end because of the denial; or • 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 disputed care or treatment; or • The issue is related to admission, availability of care, continued stay, or emergency health care services and you have not been discharged from the emergency room or transport service. You may authorize a representative to submit an expedited appeal on your behalf in writing or by contacting UMP Customer Service. An expedited appeal replaces both the first- and second-level appeals. Regence BlueShield will call you, or your authorized representative, with a decision on your expedited appeal within 72 hours of the request. Regence BlueShield will also mail a written response within 72 hours of the decision. Your provider must submit all clinically relevant information to the plan by phone or fax at: • Phone: 1-888-849-3681 (TRS: 711) • Fax: 1-877-663-7526 If you disagree with the expedited appeal decision, your provider may request an expedited external review (see the “External review (independent review)” section below). Expedited appeals for prescription drugs You or your authorized representative may submit an expedited appeal within 180 days of receiving the previous decision if you or your provider thinks you need a prescription drug immediately. You may authorize a representative to submit an appeal on your behalf in writing or by contacting WSRxS Customer Service. An expedited appeal replaces both the first- and second-level appeals. WSRxS will call you, or your authorized representative, with a decision on your expedited appeal within 72 hours of the request. WSRxS will also mail a written response within 72 hours of the decision. You or your provider must submit all clinically relevant information to the plan by phone or fax at: • Phone: 1-888-361-1611 (TRS: 711) • Fax: 1-866-923-0412 During an expedited appeal, you may choose to purchase a three-day supply at your own expense. If WSRxS decides to cover the prescription drug, WSRxS will reimburse you up to the allowed amount minus 128 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage