UMP provider portal
The Regence Fee Schedule
The Regence Fee Schedule lists the fees that apply to most providers in the Regence network. It does not include all procedure codes and prices for all network providers. The Regence Fee Schedule and other pricing information are subject to change and will be updated regularly.
Regence BlueShield network providers should reference the specific terms of their Provider Agreement for fee schedule information, or contact a Regence BlueShield Provider Consultant to confirm fee schedule information.
Payment based on the Regence Fee Schedule is subject to all of the terms and conditions of the applicable Regence BlueShield provider agreement, member benefits, Regence BlueShield policies, and all published Regence BlueShield administrative guidelines. Therefore, the fact that fees are listed for particular procedure codes does not guarantee coverage.
The Regence UMP Corner
Regence providers, please visit Regence UMP Corner for information about:
- Claims and billing information
- UMP clinical edits by code
- Sample member ID cards
- Preauthorization requirements
- Washington State Health Technology (HTCC) assessments
Joining a UMP Plus network
If you are a provider interested in joining a UMP Plus network, follow the instructions below.
- UW Medicine Accountable Care Network: Request to join the network using this online form.
- Puget Sound High Value Network: Contact Andrew Kartunen, Program Director for Growth and Strategy, at Andrew.Kartunen@virginiamason.org.
How providers are paid
UMP currently contracts with Regence BlueShield to provide a professional provider network. Providers are paid a percentage of the Regence allowed amount. The percentage paid depends on the provider’s network status, but all professional providers are paid based on the allowed amount or fee schedule.
Regence BlueShield pays an allowed amount to providers for covered services and supplies under the plan. For preferred and participating providers, the allowed amount is what the providers contractually agree to accept as payment in full for a service or supply.
For nonparticipating providers who are not accessed through the BlueCard® Program, the allowed amount is an amount Regence BlueShield determines to be reasonable charges for covered services or supplies. The allowed amount may be based upon the billed charges for some services, as determined by Regence BlueShield or as otherwise required by law.
For nonparticipating providers accessed through the BlueCard® Program, the allowed amount is the lower of the provider's billed charges and the amount that the on-site BlueCross and/or Blue Shield organization identifies to Regence BlueShield as the amount on which it would base a payment to that provider. A nonparticipating provider can bill the member for any balance due above the allowed amount.
Hospitals and other facilities
Network hospitals are paid according to a method called “Medicare Severity Diagnosis Related Groups” (MSDRG). When a patient is admitted to a hospital, he or she is assigned a primary diagnosis (for example, diabetes, pneumonia, or fractured leg). Each primary diagnosis is associated with a group—a “diagnosis related group.” The hospital is paid a certain amount for treatment associated with that group. Since some patients in a group require less treatment than average, and some require more, it all evens out in the long run. This is why you may occasionally see a bill from a hospital that is less than what the plan actually paid.
A hospital may be paid separately for procedures that don’t fall under the MSDRG treatment plan.
UMP and Regence BlueShield have no incentives or penalties to encourage providers to withhold services or minimize/avoid referrals to specialists. Regence has engaged with key provider groups to establish incentive programs that reward them for providing cost-effective, high-quality care.
Quality Improvement Program
A handful of provider groups have Quality Improvement (QIP) agreements with Regence. These provider groups can earn a higher level of reimbursement (a rate increase above and beyond the negotiated rate) if they meet one or more QIP targets. The targets are usually related to one or more of the following; increased rate of generic prescriptions, reduced unnecessary emergency room utilization, reduce hospital readmission rate (readmissions that occur within 30 days of a prior discharge), and reduced C-section rate.
Regence customer service for health care providers
For credentialing and contracting
For UMP-specific billing, claims, eligibility, preauthorization, notification, or other questions