Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield Association. Coding toolkit View our clinical edits and model claims editing. 2023 Regence BlueShield. For information on false claims, see False claims or statements in your certificate of coverage. | The following information must appear on the provider's itemized bill for the plan to consider the claim for payment: a. The ambulance claim will be processed by Blue Cross Blue Shield of Oregon. If you have questions about eligibility and enrollment:Employees:Contact your payroll or benefits office.SEBB Continuation Coverage members:Call the SEBB ProgramPhone: 1 (800) 200-1004 *If you are asking for a formulary or tiering exception, your prescribing physician must provide a statement to support your request. Please contact the Medicare Appeals Team at 1 (866) 749-0355 or submit the appeal in writing and stating you need a fast, expedited, or hot" review, or a similar notation on the paperwork. Learn more about global periods, modifiers, virtual care, unlisted codes and NCCI bypass modifiers. If services were rendered in New York or Pennsylvania, then use the state-specific file address PDF. Information current and approximate as of December 31, 2018. To send an electronic claim, use the Availity clearinghouse with payer ID HMA01. FAQs & Resources You can also get information and assistance on how to submit an appeal by calling the Customer Service number on the back of your member ID card. Send to Regence Blue Shield in accordance with the terms of your provider contract with Regence. I had an out-of-network claim for my disabled husband and they rejected it as "out of network". Note: If you submit your claim by mail, be sure to make copies of your documents for your records. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. Care Management Programs. Seattle, WA 98121, Support Phone Number: 1.888.427.0470 (toll free), Mon-Fri, 7:00 a.m. to 5:00 p.m. (PT), 1.800.AVAILITY (1.800.282.4548) (toll free), Run transactions to obtain member benefit, eligibility and claims information, Access eContracting to view and sign agreement documents, Our online newsletter (6 issues per year). Find the right fit for your next chapter with top-rated coverage and care you can trust. Regence bluecross blueshield of oregon claims address Learn about dental billing information to help ensure your dental claims are processed quickly and correctly. Blue cross blue shield address Medicaid Address and phone number - List 1 Medicaid claim submission address - List 2 Medicare . Identify BlueCard members, verify eligibility and submit claims for out-of-area patients. You must continue to use network pharmacies until you are disenrolled from our plan to receive prescription drug coverage under our formulary. Please note: This form is to be used by physicians, other professional providers or medical facilities to contact their assigned provider relations representatives. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) Select a State. Examples: medical doctor, osteopath, optometrist, chiropractor, physical therapist, audiologist, independent laboratory, nurse practitioner, durable Regence BlueCross BlueShield of Oregon Notice will include explanation why an extension is needed and when the plan expects to act on the claim. Contact us - Regence **If you, or your prescribing physician, believe that waiting for a standard decision (which will be provided within 72 hours) could seriously harm your life, health or ability to regain maximum function, you can ask for an expedited decision. Regence BlueShield of Idaho is an independent licensee of the Blue Cross and Blue Shield Association. If MAXIMUS disagrees with our decision, we authorize or pay for the requested services within the timeframe outlined by MAXIMUS. 4 0 obj The Centers for Medicare & Medicaid Services values your feedback and will use it to continue to improve the quality of the Medicare program. The plan must receive all relevant information with the appeal to make sure the most accurate decision is made. Our award-winning Customer Service team is made of compassionate people who care. Claims submission - Regence You may send a complaint to us in writing or by calling Customer Service. CLAIM.MD | Payer Information | OR BCBS (Regence) Step 2: Next, locate the "Login" button at the top-right corner. endobj 2 0 obj Deutsch | Regence BlueCross BlueShield of Oregon providers located in Clark County, Washington: Within 24 months after payment of the claim or notice that the claim was denied or within 30 months for claims subject to coordination of benefits. Centers of Excellence and Washington State Prescription Services do not provide BlueCross BlueShield services and are separate companies solely responsible for their products/services. Find helpful phone, fax and email information for assistance. You may need to submit your own claim if you buy drugs at a non-network pharmacy, dont show your ID card, or have other prescription coverage that pays first and UMP is secondary. Regence BlueCross BlueShield of Oregon. REGENCE BS OF UTAH. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. When we make a decision about what services we will cover or how well pay for them, we let you know. For Providers | Healthcare Management Administrators | Healthcare Prescription questions?Call Customer Service and choose the Pharmacy option. Recommended Reviews. If you have . Regence BlueCross BlueShield of Oregon, headquartered in Portland, has been serving Oregonians since 1941 and now provides more than 974,000 people with comprehensive health insurance solutions. 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. When you use a network provider or network pharmacy, you dont need to submit a claimthe provider or pharmacy will do it for you. MAXIMUS will review the file and ensure that our decision is accurate. See "Appeals related to eligibility" section of your plan's. Procedure and diagnosis (codes) or description of the injury or illness, d. Provider's name, address, phone number, and National Provider Identifier (NPI) or Tax ID number, e. For ambulance claims, also include the ZIP code where the member was picked up and where they were taken. We will ask your permission if we need more time to respond. Congestive Heart Failure. You have other insurance that pays first and UMP is secondary. If you are a member of another air ambulance's membership program that is a reciprocal partner of Life Flight Network, please make sure you report this to our billing office at (866) 883-9998. Learn more about billing and how to submit claims to us for payment, including claims for BlueCross and BlueShield Federal Employee Program (BCBS FEP) members. Coverage decision requests can be submitted by you or your prescribing physician by calling us or faxing your request. 2003 Western Ave # 600, For prescription drug coverage, show both plan cards to the pharmacy and make sure they know which plan to bill first. Though it is not required, you may want to include the UMP Appeals and Grievance form (for medical services) or the Washington State Rx Services Complaint and Appeal Form (for prescription drugs) with your appeal. Cancel Proceed User name or email For more information about the appeals process, including expedited appeals for urgent or life-threatening conditions and requesting an external review by an Independent Review Organization, read the "Complaint and appeal procedures" section in your plan's certificate of coverage. PO Box 91102Seattle, WA 98111-9202. Media Contact: Audrey Glasby Regence BlueCross BlueShield of Utah Regence . Regence Direct Member Reimbursement Form Claims edits If you do not submit your claims through Availity Essentials, follow this process to submit your claims to us electronically. You or your authorized representative (including a relative, friend, advocate, attorney, or provider) may submit an appeal by using the methods described in the Where to send complaints or appeals section below or by calling UMP Customer Service (medical appeals) or WSRxS Customer Service (prescription drug appeals). Asthma. A list of reciprocal partners as well as membership benefits can be found at lifeflight.org. Facility Services are services received for the use of a facility such as a hospital, emergency room, freestanding ambulatory facility, attended sleep study at outpatient part of a hospital, alcohol treatment facility or residential UMP may cover some supplies through the medical benefit and other supplies under the prescription drug benefit. Washington State Rx ServicesPO Box 40168Portland, OR 97240-0168. If you have questions, contact Premera at 1 (855) 784-4563 (TRS: 711) Monday through Friday 7 a.m. to 5 p.m. (Pacific). Many issues may be resolved with a phone call. Were empathetic, reliable and tenacious, too. Tagalog | Blue Cross and Blue Shield of Nevada will process the claim. Products and networks Learn more about the products we offer and the provider networks that support them. All from Regence, a company committed to service, community and this place we call home. Medical records from your provider, if applicable. Step 2: Next, locate the "Login" button at the top-right corner. The members full name (the name of the employee, retiree, or dependent covered by the plan), The member ID number (starting with a W on your UMP member ID card), The name(s) of any providers involved in the issue you are appealing, A statement describing the issue and your desired outcome, A copy of the Explanation of Benefits, if applicable, or a list of the claim numbers you are appealing. Subscribe to online communications receive newsletters and important news via email. All from Regence, a company committed to service, community and this place we call home. Dental billing. Quickly identify members and the type of coverage they have. TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m EST., Monday through Friday. PDF Member Reimbursement Form Ting Vit | TRS: 711Business hours: Monday through Friday 8 a.m. to 4:30 p.m. (Pacific). To obtain information on the aggregate number of grievances, appeals and exceptions filed with the plan contact Customer Service. TTY users should call, 1-800-325-0778; or your Medicaid Office. Regence Blue Shield in accordance with the terms of your provider contract with Regence. Location. CLAIM.MD | Payer Information | OR BCBS (Regence) Payer Information OR BCBS (Regence) Payer ID: 00851 This insurance is also known as: Regence Blue Cross of Oregon Blue Cross Blue Shield of OR REGENCE BLUECROSS BLUESHIELD OF OREGON REGENCE BCBS OF OREGON FEP G00851 Other ID's: 12B41, SB850 Need to submit transactions to this insurance carrier? Billing | Life Flight Network Step 4: After you have completed the login details correctly . Mail or fax both the claim form and the provider's claim document (or bill) to: Regence BlueShield Attn: UMP Claims P.O. Any enrollee may appeal a decision made by the School Employees Benefits Board (SEBB) Program regarding SEBB eligibility, enrollment, premium payments, or premium surcharges (if applicable) to the SEBB Appeals Unit. Regency Blue Cross Blue Shield Of Oregon (541) 772-8906 Visit Website Map & Directions 2057 Commerce Dr Medford, OR 97504 Write a Review. For more specific contact information, choose from the following: Individuals and familiesMedicareEmployersProducersProviders. Appeal form (PDF): Use this form to make your written appeal. If you wish to appoint someone to act on your behalf, you must complete an appointment of representative form and send it to us with your prescription coverage determination form. If you have any questions about your member appeal process, call our Customer Service department at the number on the back of your member ID card. This is the customer service number for questions about your health insurance coverage, benefits or treatment. Regence BlueCross BlueShield of Utah is an independent licensee of the Blue Cross and Blue Shield Association. We are now processing credentialing applications submitted on or before March 6, 2023. See our FAQs for more claim information and contacts. If you have other medical or prescription coverage, Washington State Rx Services Complaint and Appeal Form, WSRxS Multiple Pharmacy Coverage Inquiry Form (Drug Coordination of Benefits). PO BOX 25956 SALT LAKE CITY, UT 84125 800-662-0876. For more specific contact information, choose from the following: Individuals and families Medicare Employers Producers Providers Fraud or abuse You can remain anonymous. You can submit feedback about your Medicare health plan or prescription drug plan directly to Medicare. If you have questions, contact Washington State Rx Services Customer Service at 1 (888) 361-1611 (TRS: 711) Monday through Friday 7:30 a.m. to 5:30 p.m. (Pacific). Din kehji k'eyeedgo, t' shdi k anidaalwoi bi bsh bee hane ninaaltsoos bee atah nilinigii bined bik. Download a form to use to appeal by email, mail or fax. Excluded pharmacies are pharmacies that have been excluded due to fraud, waste, or abuse. Please follow Claims and payment Claims submission Claims submission Claim attachments Learn more about when, and how, to submit claim attachments. In addition, you cannot obtain a brand-name drug for the copayment that applies to the generic drug. Claims & payment - Regence 1-800-962-2731. Note:TovieworprintaPDFdocument,youneed AdobeReader. 6:00 AM - 5:00 PM ASTFax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals only)Fax: 866-948-8823 (FEP Care Make sure Costco Mail Order Pharmacy or PPS has the information for both plans and knows which plan is primary. Ask your provider. You can submit a claim online through your Regence account, or you can fax or mail your claim to Regence. Follow the prompts to submit your claim online. Professional Services are performed by a doctor or other healthcare professional. No enrollment needed, submitters will receive this transaction automatically, Web portal only: Referral request, referral inquiry and pre-authorization request, Implementation Acknowledgement for Health Care Insurance. BCBS State by State | Blue Cross Blue Shield. Attn: Member Appeals Search jobs. Don't have a Regence account yet? Phoenix, AZ 85072, Retail Pharmacy Program 1 0 obj Regence BlueShield serves select counties in the state of Washington and is an independent licensee of the Blue Cross and Blue Shield Association. Stay up to date on what's happening from Salt Lake to St. George. They are also available outside these hours with limited services. Read the "Guidelines for prescription drugs UMP covers" section of your certificate of coverage for details. Uniform Medical Plan (UMP) is a self-insured Preferred Provider Organization (PPO) medical plan offered through the Washington State Health Care Authority. Italiano | Premera Blue Cross Blue Shield of Alaska - FEP PO Box 33932 Seattle, WA 98133-0932 Phone: 800-562-1011 6:00 AM - 5:00 PM AST Fax: 877-239-3390 (Claims and Customer Service) Fax: 877-202-3149 (Member Appeals only) Fax: 866-948-8823 (FEP Care Management - prior auth/pre-service requests) Email Members: Log in or register - MyBlue Customer eService