Step 1: Start your internet browser, and then go to the official regence bluecross blueshield of oregon address website. Sign in Visit the Regence provider website, regence.com to learn more about: Contact Us View information about who to contact for questions and issues. Phone:800-562-1011Fax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals)Fax: 866-948-8823 (FEP Care Management - prior auth/pre-service requests), Email: Step 2: Next, locate the "Login" button at the top-right corner. It was formed in 1982 from the merger of its two namesake organizations: Blue Cross was founded in 1929 and became the Blue Cross Association in 1960, while . We must notify you of our decision about your grievance within 30 calendar days after receiving your grievance. The ambulance claim will be processed by Blue Cross Blue Shield of Oregon. The plan will notify you within the 30-day period that an extension is necessary, with a description of the information needed and why it is needed. Coronary Artery Disease. A decision to deny, modify, reduce, or terminate payment, coverage, certification, or provision of health care services or benefits, including the admission to, or continued stay in, a health care facility. For prescription drug coverage, show both plan cards to the pharmacy and make sure they know which plan to bill first. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> | Appropriate staff members who were not involved in the earlier decision will review the appeal. See what were doing in your community to keep people safe and healthy. Consult theFEP local plan directory to find addresses and telephone numbers You can appeal a decision online; in writing using email, mail or fax; or verbally. Step 4: After you have completed the login details correctly . PO Box 1271 MS C7APortland, OR 97207-1271 This form is to be used only for services in Oregon and Clark County, WA. Lastly mail the completed claim form to the address provided. Box 30805 Salt Lake City, UT 84130- 0805 *Pennsylvania BCNEPA P.O. Some of the limits and restrictions to prescription drug coverage will apply when UMP pays second to another plan. All from Regence, a company committed to service, community and this place we call home. 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 If your prescribing physician asks for a faster decision for you, or supports you in asking for one by stating (in writing or through a phone call to us) that he or she agrees that waiting 72 hours could seriously harm your life, health or ability to regain maximum function, we will give you a decision within 24 hours. 0. . Regence Provider Appeal Form Special Message: Coming soon, you will be able to dispute (appeal) a claim on Availity from the claim status result page. Provider Representative Contact Form - Regence Find forms that will aid you in the coverage decision, grievance or appeal process. The plan will decide on your expedited appeal within 72 hours of the request. Send your claim or correspondence to the Blue Cross Blue Shield plan in the state where the laboratory work was sent for testing.Example: The lab service you used is in Arizona but the sample was sent to Nevada for analysis. 2003 Western Ave # 600, Programs View our programs and requirements for radiology, inpatient admissions and patient care management. Medical records from your provider, if applicable. Dissatisfaction with service provided by the health plan. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) endobj Premera Blue Cross Blue Shield of Alaska FEP PO Box 33932 Seattle, WA 98133-0932, Phone:800-562-1011 <> CLAIM.MD | Payer Information | OR BCBS (Regence) Regence Bluecross Blueshield of Oregon - Dun & Bradstreet We know it is essential for you to receive payment promptly. Instructions are included on how to complete and submit the form. A complaint or grievance is an oral statement or written document submitted by or on behalf of a member regarding: Note: If your issue is regarding a denial, reduction, or termination of payment or non-provision of medical services, it is an appeal. Blue Cross Blue shield claim submission address | Medical Billing and Deutsch | Oregon's Sustainable Cost Growth program, and the ability the state's Regence BlueCross BlueShield of Utah. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. This 30-day period may be extended by 15 days when action cannot be taken on the claim due to: Manage your claimsSee the status of your claims, see how much you owe, find a specific claim, and more by logging in to your Regence account. Franais | Submit a Preauthorization Request Need help with a claim? Location. Uniform Medical Plan (UMP) is a self-insured Preferred Provider Organization (PPO) medical plan offered through the Washington State Health Care Authority. Make sure you have your Member ID card handy when you call us. 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). Members: Log in/register at MyBlue Customer eService, Regence Blue Cross Blue Shield of Oregon - FEPPO Box 31105Salt Lake City, UT 84131, Regence Blue Cross Blue Shield of Oregon - FEPPO Box 1269Portland, OR 97207. Regence BlueCross BlueShield Medicare Advantage Plans in Oregon Claims and clinical appeals address: PO Box 21702 Eagan, MN 55121 Care management Phone: 844-996-0329 Fax: 888-302-9325 2023 holiday closures January 2 May 29 July 4 September 4 November 23 November 24 December 25 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. You can also download the appeal form and submit your written appeal by email, fax, or mail:Email: UMPMemberAppeals@regence.comFax: 1 (877) 663-7526, Mail:UMP Appeals and GrievancesRegence BlueShieldPO Box 91015Seattle, WA 98111-9115. Information current and approximate as of December 31, 2018. complies with applicable Federal and Washington state civil rights laws, Determine the county where the service was performed* (see exceptions below). | Choose the right company to process your complaints and appeals: To appeal online, sign in to your Regence account, select Programs & Resources, and select Appeals. Read the "Guidelines for prescription drugs UMP covers" section of your certificate of coverage for details. First, you'll need to gather these documents: An itemized bill from your provider that describes the services and charges. Learn more about global periods, modifiers, virtual care, unlisted codes and NCCI bypass modifiers. Coding toolkit REGENCE BS OF UTAH. **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. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. You have the right to appeal, or request an independent review of, any action we take or decision we make about your coverage, benefits or services. Learn about dental billing information to help ensure your dental claims are processed quickly and correctly. Kreyl Ayisyen | In every state and every community, BCBS companies are making a difference not just for our members, but For the Health of America. Examples: medical doctor, osteopath, optometrist, chiropractor, physical therapist, audiologist, independent laboratory, nurse practitioner, durable TRS: 711Business hours: Monday through Friday 8 a.m. to 4:30 p.m. (Pacific). I . But there are some circumstances where you will need to submit a claim. For Providers | Healthcare Management Administrators | Healthcare Attn: Member Appeals Quickly identify members and the type of coverage they have. If UMP is secondary, you must include a copy of your primary plan's Explanation of Benefits, which lists the services covered and how much the other plan paid. % All claims must be submitted to UMP within 12 months of the date of service or purchase to prevent denial of the claim. Learn about Regence Lewiston, ID office. Select a State. Claims submission - Regence Claims edits If you do not submit your claims through Availity Essentials, follow this process to submit your claims to us electronically. Professional Services are performed by a doctor or other healthcare professional. x][o%~`C?3=k7A I87ggglM"_Unx9d,*Wdx cwU74/_C&$jTD/ew|/_t_~suJo~/X7/fTjz=u?|1w_k;vZ]!w??!~pw!cw DG6JOw{v?M.>~h9{/|0 _&CrOL%be_/WWc9U~;?#*bX Fz-w~7`e_ :5ZmLme'UFSgs\\@=~!r)Q;ZDf}Z1^W8qw`v0]wcEo5tLBn-4%x\I[s$8eBM:)$2dY9s>E;& Requests to find out if a medical service or procedure is covered. Complete and send your appeal entirely online. 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. View our clinical edits and model claims editing. Make sure Costco Mail Order Pharmacy or PPS has the information for both plans and knows which plan is primary. Call customer service and web support at 800-607-0546 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. Why choose Regence Individual & family plans To see if you qualify for Extra Help, call: 1-800-633-4227. 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. If you wish to appoint someone to act on your behalf, you must complete an appointment of representative form (PDF) and send it to us with your grievance form (PDF). Products and networks Learn more about the products we offer and the provider networks that support them. To obtain information on the aggregate number of grievances, appeals and exceptions filed with the plan contact Customer Service. If MAXIMUS disagrees with our decision, we authorize or pay for the requested services within the timeframe outlined by MAXIMUS. Regence Blue Shield in accordance with the terms of your provider contract with Regence. . Call the phone number on the back of your member ID card. Regence BlueCross BlueShield of Oregon is an independent licensee of the Blue Cross and Blue Shield Association. If the decision was after the 60-day timeframe, please include the reason you delayed filing the appeal. If you want a written response, you must request one. Please follow 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 Please do not submit attachments (e.g., X-rays, periodontal chartings) with your pretreatment estimate or initial claims submission. Allied professionals, including behavioral health, vision, chiropractic and other complementary service providers: Contact your allied provider relations representatives & consultants. Your life. An appeal for services related to the Centers of Excellence Program must be submitted within 180 days after you receive notice of the denial to Premera.Submit appeals to: Mail:Premera Blue Cross Manage your claimsGet your prescription claims history, view your benefits and claims information, and more by logging in to your Washington State Rx Services Account. View the toolkit Claims submission 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. Recommended Reviews. Be sure to include any other information you want considered in the appeal. WELLMARK BCBS OF IOWA. Regence BlueShield. Yelp users haven't asked any questions yet about Regence Blue Cross Blue Shield of Oregon. ), Tel:800-562-1011Fax: 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), Premera Blue Cross - FEPPO Box 33932Seattle, WA 98133, Retail Pharmacy Program See how our affordable Regence plans offer coverage, access and convenienceso you can live your best. Waiting too long on the phone, waiting room, in the exam room or when getting a prescription, The length of time required to fill a prescription or the accuracy of filling a prescription, Access to health care benefits, including a pre-authorization request denial, Claims payment, handling or reimbursement for health care services, A person who has bought insurance for themselves (also called a contract holder) and any dependents they choose to enroll. Regence users: make the switch to the Availity Web Portal You have been redirected from the Regence or Asuris Northwest Health Provider Center. 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). Coordination of Benefits, Medicare crossover and other party liability or subrogation. We stay on top of issues until theyre resolved. We will ask your permission if we need more time to respond. <>>> Phoenix, AZ 85072, Phone:800-562-1011 The quality of care you received from a provider or facility. If we must request additional information, the processing of your claim may be delayed. Contact Us | FEP | Premera Blue Cross For services outside this area, please contact customer service directly at 1 (800) 365-3155 as your claim will require special handling. 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. For more specific contact information, choose from the following: Individuals and familiesMedicareEmployersProducersProviders. Provider home - Regence Your trust is our top concern, so businesses can't pay to alter or remove their reviews. Member's name and member ID number, including the alpha prefix (three letters and the "W" before member ID number), b. Please note: This form is to be used by physicians, other professional providers or medical facilities to contact their assigned provider relations representatives. Regence: The most trusted name in health insurance Experience life with Blue With a plan powered by the most trusted name in health insurance, you'll have coverage tailored to your health. 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. For information on false claims, see False claims or statements in your certificate of coverage. 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. Management - prior auth/pre-service requests), Email: Members: Log in/register at MyBlue Customer eService, Regence BlueShield - FEPPO Box 21709Seattle, WA 98111. You get a vaccine or flu shot from an out-of-network provider. Email: Send email through your WSRxS account at ump.regence.com/sebb/benefits/prescriptionsNote: This email is not secure. Box 1106Lewiston, ID 83501-1106. Completion of the credentialing process takes 30-60 days. You must submit the claim to Regence as a medical claim. Regence BlueShield of Idaho | Regence See Complaints about quality of care in your certificate of coverage to learn more. PDF Local Blue Cross and Blue Shield Mailing Addresses State/Alpha Prefix Diabetes. In addition, you cannot obtain a brand-name drug for the copayment that applies to the generic drug. Mail or fax both the claim form and the provider's claim document (or bill) to: Regence BlueShieldAttn: UMP ClaimsP.O. Lastupdated01/23/2023Y0062_2023_M_MEDICARE. While it's a good idea to submit a complaint as soon as possible, there isn't a deadline to do so. Claims not submitted to UMP within 12 months of the date of service will not be paid. Box 890179 Camp Hill, PA 17089 If you have questions about submitting a claim for services outside the U.S., call UMP Customer Service.. Claims determinations The plan will notify you of action taken on a claim within 30 days of the plan receiving it. Learn how our innovative solutions can help your employees live healthier, while helping you manage your costs. 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. Select the area of the map that matches the color of the county where the service was performed. UMP medical plans are administered by Regence BlueShield. Lack of information. If you do not submit your claims through Availity Essentials, follow this process to submit your claims to us electronically. Information current and approximate as of December 31, 2018. BCBS State by State | Blue Cross Blue Shield.
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