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, including Visit: covermymeds.com 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 to Visit: UMP commonly used forms available online webpage at make sure your claims are processed ump.regence.com/pebb/forms/common-forms and under correctly. You may fax, email, or mail Prescription drug forms choose the “WSRxS Multiple the “WSRxS Multiple Prescription Prescription Drug Coverage Inquiry” form Drug Coverage Inquiry” form to Fax: 1-855-668-8550 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 Select (PEBB) Certificate of Coverage 7