UMP Plus provider information

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What's a UMP Plus network provider?

Network providers are in either the core or support networks:

  • Core network — contains primary care providers (PCP), specialty providers, ancillary providers, and facilities (such as hospitals and clinics) contracted with your UMP Plus network.* Most covered services are paid at 100 percent when you see your PCP and 85 percent for all other providers in this network. Provider will not bill you for charges that exceed the allowed amount.
  • Support network — contains certain providers contracted with Regence but not in your UMP Plus network. All of the providers in this network are ancillary. Most services are paid at 85 percent, and providers will not bill you for charges that exceed the allowed amount.

Out-of-network provider are not in the core or support networks. If you see a provider with Regence who is not in the core or support network, they are considered out-of-network. Most covered services are paid at 50 percent of the allowed amount, and providers may bill you for charges that exceed the allowed amount (balance billing). 

Alert: Some providers are network providers at one location but not another. Please call UMP Customer Service at 1-888-849-3681 (TRS: 711) if you have questions about the network status of a provider at a specific location.

*UMP Plus has two separate networks: Puget Sound High Value Network (PSHVN) and UW Medicine Accountable Care Network (UW Medicine ACN). To get the best use of your benefits, use providers in the network you enrolled in. 

Network provider types

You have access to the following provider types through the core and support networks.

  • Network primary care providers, such as family practice, adult medicine, or women’s health.
  • Network specialty providers, such as cardiologists, dermatologists, or allergists.
  • Ancillary providers, such as chiropractors, mental (behavioral) health providers, or physical therapists.
  • Network facilities, such as hospitals or clinics.

Note: When you see a network provider at a facility (such as a hospital), check that the facility is also in the network.

Tip: A primary care provider helps you receive preventive care, such as covered immunizations, well-child visits for your children, and cancer screenings, and can help coordinate care for you when you need to see specialists.

To receive full coverage for primary care office visits, you must see a primary care provider (PCP) in the core network (or a naturopath from the support network). A PCP must be a medical doctor, doctor of Osteopathic Medicine, naturopathic physician, nurse practitioner, or physician’s assistant in the core network (or a naturopath in the support network) who specializes in one of the following:

  • Adult medicine
  • Family practice
  • General practice
  • Geriatrics
  • Internal medicine
  • Obstetrics, Gynecology, or OB/GYN
  • Pediatrics (for patients under age 18)
  • Preventive medicine
  • Women’s health

When you see a PCP for primary care services, office visits are paid at 100 percent. Related services, such as x-rays or labs, that you receive during a primary care visit may be subject to your medical deductible and coinsurance.

If you see an out-of-network PCP, you pay 50 percent of the allowed amount and the provider may balance bill you.

A specialty provider is in the core network and specializes in a certain area of care. Examples include cardiologists, allergists, and dermatologists. To find the complete list, visit your network's provider search (PSHVN and UW Medicine ACN) and click on the "Specialty" drop-down menu.

For most covered services with specialty providers, you pay 15 percent of the allowed amount after meeting your medical deductible.

If you see an out-of-network specialist, you pay 50 percent of the allowed amount, and the provider may balance bill you.

An ancillary provider is one of the provider or facility types listed below. Ancillary providers may be available in both the core and support networks.

Ancillary facilities Ancillary providers
  • Birth centers
  • Dialysis
  • Durable medical equipment suppliers
  • Hearing aid dispensary
  • Home health providers
  • Hospice
  • Laboratories (lab testing)
  • Mental (behavioral) health facilities
  • Rehabilitation, inpatient
  • Skilled nursing facility
  • Substance use disorder facilities
  • Urgent care
  • Acupuncturists
  • Anesthesiologists
  • Audiologists
  • Chiropractors
  • Massage therapists, licensed
  • Maxillofacial surgeons
  • Mental (behavioral) health providers (including M.D.s, such as psychiatrists)
  • Midwives, licensed
  • Occupational therapists
  • Pathologists
  • Physical therapists
  • Registered dietitians
  • Speech therapists
  • Substance use disorder providers

For ancillary providers in the core or support network, you pay 15 percent of the allowed amount for covered services.

If you see an out-of-network ancillary provider, you pay 50 percent of the allowed amount and the provider may balance bill you.

Clinics and other outpatient facilities

At clinics in the core network and other outpatient facilities, you pay 15 percent of the allowed amount for covered services. When you see a network provider at a facility (such as a clinic), confirm that the facility is also a network provider.

Urgent care clinics: When you see a provider at an urgent care clinic in the core or support networks, you pay 15 percent of the allowed amount.

Hospitals

Inpatient services: At hospitals in the core network, you pay an inpatient copay of $200 per day, up to an annual maximum of $600. You pay 15 percent of the allowed amount for professional services.

Outpatient services: At hospitals in the core network, you pay 15 percent of the allowed amount. You may be balance billed at out-of-network hospitals.

You can find more information on the summary of benefits webpage under "Emergency room" or “Hospital services.”

Alert! Non-medical emergencies treated at an out-of-network emergency room may not be covered. If the plan does pay, it will be at the out-of-network rate.

Who can I see for emergency or urgent care?

Emergency care

If your emergency room visit is determined to be a medical emergency, it will be paid at the network rate for network and out-of-network facilities.

You may also have an emergency room copayment. Learn more about emergency room visits on the summary of benefits webpage under “Emergency room.”

Urgent care

You may visit urgent care clinics in the core or support network, and you will pay 15 percent of the allowed amount. If you visit an out-of-network provider, you will pay 50 percent of the allowed amount and the provider may balance bill you.

Who can I see for specific services, like bariatric surgery?

For specific services like bariatric surgery or transgender services, you may see a provider from either your UMP Plus network or the Regence network and receive the network rate. For most covered services, this means you will pay 15 percent of the allowed amount after meeting your deductible.

See your plan’s certificate of coverage (PSHVN or UW Medicine ACN) for a full list of services that fit into this category.

What is a covered provider type?

UMP Plus pays for covered services only when performed by covered provider types working within the scope of their licenses. All providers in the core and support networks are covered provider types. 

Click on "Covered provider types" below to see the full list. 

If you see an out-of-network provider that is a noncovered provider type, the plan will not pay for any of the services received. You will be responsible for all charges. Payments for those charges will not count toward your medical deductible or medical out-of-pocket limit.

Provider specialty type code Provider specialty type name
ARNP Advanced registered nurse practitioner
AUD Audiologist
BCBA Licensed behavior analyst
CGC Licensed genetics counselor
CN Certified nutritionist
CNM Certified nurse midwife
CRNA Certified registered nurse anesthetist
DC Chiropractic physician
DDS or DMD Dentist
DO Osteopathic physician
DPM Podiatric physician
EAMP East Asian medicine practitioner
LAC Acupuncturist
LCSW Licensed clinical social worker
LM Licensed midwife
LMFT Licensed marriage and family therapist
LMHC Licensed mental health counselor
LMP Licensed massage practitioner
MD/DO Physician
ND Naturopathic physician
OD Optometric physician
OT Occupational therapist
PA Licensed physician assistant/physician assistant certified
PharmD Pharmacist
PhD, PsyD, EdD Psychologist
PT Physical therapist
RD Registered dietitian
RN Licensed registered nurse
SLP Speech language pathologist

Contact

UMP Customer Service
Online: Your Regence account
Phone: 1-888-849-3681
TRS: 711 
Business hours: Monday through Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. (Pacific)

Puget Sound High Value Network (PSHVN)
Phone: 1-855-776-9503
Business hours: Monday through Friday 6:30 a.m. to 8 p.m. and Saturday 7 a.m. to 6 p.m. (Pacific)

UW Medicine Accountable Care Network
Phone: 1-855-520-9500
TRS: 711
Business hours: Monday through Saturday 7 a.m. to 7 p.m. (Pacific)