Contact type and description Contact information Visit: ardonhealth.com Email: [email protected] (This email is not secure.) Prescription drug appeals and WSRxS complaints Call: 1-888-361-1611 (TRS: 711) Monday–Friday: 7:30 a.m. to 5:30 p.m. (Pacific) Fax appeals to: 1-866-923-0412 Mail: WSRxS Attn: Appeal Unit PO Box 40168 Portland, OR 97240-0168 Prescription drug WSRxS preauthorization Call: 1-888-361-1611 (TRS: 711) For providers and pharmacists Monday–Friday: 7:30 a.m. to 5:30 p.m. (Pacific) submitting prescription drug Fax: 1-800-207-8235 preauthorization requests, Visit: covermymeds.com including requests for an exception for noncovered prescription drugs or changing quantity limits Prescription drug claims WSRxS Call: 1-888-361-1611 (TRS: 711) Monday–Friday: 7:30 a.m. to 5:30 p.m. (Pacific) Fax: 1-855-668-8550 Mail: Pharmacy Manual Claims PO Box 999 Appleton, WI 54912-0999 Visit: Find claim forms by visiting forms and publications at hca.wa.gov/ump-forms-pubs Coordination of benefits WSRxS Contact WSRxS if you or your Call: 1-888-361-1611 (TRS: 711) to request a form. dependents have other insurance Visit: UMP commonly used forms available online webpage at to make sure your claims are ump.regence.com/pebb/forms/common-forms and under processed correctly. You may fax, Prescription drug forms choose the “WSRxS Multiple Prescription email, or mail the “WSRxS Drug Coverage Inquiry” form Multiple Prescription Drug Fax: 1-855-668-8550 Coverage Inquiry” form to WSRxS. Email: Send email through your WSRxS account at ump.regence.com/pebb/benefits/prescriptions. (This email is not secure.) Mail: Pharmacy Manual Claims PO Box 999 Appleton, WI 54912-0999 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage 7