Submitting a claim

When Uniform Medical Plan (UMP) is your primary insurance and your provider is preferred (called "network" for UMP Plus), you don't need to submit claims; the provider will do it for you.

But there are some circumstances where you will need to submit a claim to the plan. If you have a question about whether your provider's office has submitted a claim, log in to your account at regence.com or call UMP Customer Service at 1-888-849-3681.

This page is about medical claims. Learn about prescription drug claims in the Search FAQs section of the website.

Medical service outside the U.S.

When do I need to submit a medical claim?

You may need to submit a claim to UMP for payment if:

Out-of-network providers may submit a claim on your behalf; ask the provider.

TIP: If you get a vaccine (including a flu shot) from an out-of-network provider, you must submit the claim to Regence as a medical claim.

How do I submit a medical claim?

To submit a claim yourself, you'll need to fill out and mail these documents:

  1. The Medical Claim Form.
  2. An itemized bill from your provider that describes the services you received and the charges. The following information must appear on the provider's itemized bill for the plan to consider the claim for payment:
    • Patient's name and plan ID number, including the alpha prefix (three letters before ID number).
    • Description of the injury or illness.
    • Date and type of service.
    • Provider's name, address, and phone number.
    • For ambulance claims, please also include where the patient was picked up and where they were taken.
  3. If UMP pays second, 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. 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. Claims not submitted to UMP within 12 months of the date of service will not be paid.

TIP: If you purchase contact lenses or eyeglasses from an out-of-network provider that doesn't bill your plan, you will need to submit a claim for reimbursement using the Vision Claim Form.

If we have to request more information, the processing of your claim may be delayed.

Reimbursement for services received from an out-of-network provider may be sent to the provider or to you in the form of a check listing both you and the provider as payees.

Always make copies of your documents for your records. Then, mail both the claim form and the provider's claim document (or bill) to:

Regence BlueShield
Attn: UMP Claims
PO Box 1106

Lewiston, ID 83501-1106
(or by fax to: 1-877-357-3418)

Call Customer Service at 1-888-849-3681 if you have a question about the processing of your claim.

Important information about submitting medical claims

You or your provider must submit claims within 12 months of the date you received health care services; this is called the "timely filing" deadline. The plan will not pay claims submitted more than 12 months after the date of service.

If you or a family member have other health care coverage that pays first, and that primary plan delays payment on a claim, you should still submit the claim to UMP within 12 months to prevent denial. See the "If You Have Other Medical Coverage" section in your 2017 Certificate of Coverage for information on how UMP coordinates benefits with other plans.

For information about submitting claims for services outside of the United States, see Coverage of services outside the United States. You may have to pay services upfront and submit a claim for reimbursement.

TIP: To prevent errors and delays in claim processing, always tell your providers promptly if your coverage changes.

Claims Reimbursement

Most of the time, the plan will pay preferred providers directly. For claims submitted by you or an out-of-network provider, the plan will determine whether to pay you, the provider, or both you and the provider. For a child covered by a legal qualified medical child support order (QMCSO), the plan may pay the custodial parent or legal guardian of the child.

Claims Determinations

You will be notified of action taken on a claim within 30 days of the plan receiving it. This 30-day period may be extended by 15 days when action cannot be taken on the claim due to:

  • Circumstances beyond the plan's control. Notification will include an explanation why an extension is necessary and when the plan expects to take action on the claim.
  • Lack of information. The plan will notify you within the 30-day period that an extension is necessary, with a description of the information needed as well as why it is needed.

If the plan is asking you for more information, you will be allowed at least 45 days to provide it. If the plan doesn't receive the information requested within the time allowed, the claim will be denied.

Contact

Question about submitting a claim?

Medical services

UMP Customer Service
Phone: 1-888-849-3681 (TTY 711)
TTY: 711
Business hours: Monday–Friday 7 a.m. to 5 p.m. Pacific Time (PT)

Prescription drugs

Washington State Rx Services
Phone: 1-888-361-1611
TDD: 1-800-433-6313
Business hours: Monday-Friday 7:30 a.m. to 5:30 p.m. PT