- 7. Mai 2023
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- Category: Allgemein
Learn more on the HCA website. This form is to be used to request a deduction on a future remittance advice (voucher) in response to a recent recoupment request from Regence, or as a result of an overpayment discovered by your internal claims review process. Oral coverage decision requests1 (855) 522-8896 To request or check the status of a redetermination (appeal): 1 (866) 749-0355 Fax numbersAppeals and grievances: 1 (888) 309-8784Prescription coverage decisions: 1 (888) 335-3016 endobj | We are now processing credentialing applications submitted on or before March 6, 2023. 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. 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. Email: Send email through your WSRxS account at ump.regence.com/sebb/benefits/prescriptionsNote: This email is not secure. Learn how our innovative solutions can help your employees live healthier, while helping you manage your costs. You may only disenroll or switch prescription drug plans under certain circumstances. We respond to pharmacy requests within 72 hours for standard requests and 24 hours for expedited requests. You have the right to file a grievance, or complaint, about us or one of our plan providers for matters other than payment or coverage disputes. 10/18) v2 INSTRUCTIONS FOR FILING A CLAIM IMPORTANT: Use this form for all medical, pharmacy, dental, and vision services covered by Regence. Learn more about informational, preventive services and functional modifiers. Franais | Regence BlueShield - FEPPO Box 31207Salt Lake City, UT 84131, (Attended sleep study at outpatient part of a hospital, home hospice, organ/tissue transplants, clinical trials. Box 30805 Salt Lake City, UT 84130- 0805 *Pennsylvania BCNEPA P.O. But there are some circumstances where you will need to submit a claim. To appeal by phone or if you have questions, contact UMP Customer Service at 1 (800) 628-3481 (TRS: 711) Monday through Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. (Pacific). 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. See Occupational injury or illness (workers' compensation) claims in your certificate of coverage. Tagalog | endobj 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;& Many issues may be resolved with a phone call. You may need to submit a claim to UMP for payment if: UMP does not cover nor coordinate benefits with workers' compensation claims. Learn more about our customized editing rules, including clinical edits, bundling edits, and outpatient code editor. Regence BlueCross BlueShield of Oregon is an independent licensee of the Blue Cross and Blue Shield Association. Complete the Prescription Drug Claim Form and send it with your pharmacy receipts to: Pharmacy Manual ClaimsP.O. For knee and hip replacement and spine care. Blue cross blue shield address Medicaid Address and phone number - List 1 Medicaid claim submission address - List 2 Medicare . 24/7 anonymous hotline: 1 (800) 323-1693 Medicare Part C & D: 1 (800) 633-4227 Online reporting form Ethics & compliance hotline See "Appeals related to eligibility" section of your plan's. 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. For prescription drug coverage, show both plan cards to the pharmacy and make sure they know which plan to bill first. You can submit a claim online through your Regence account, or you can fax or mail your claim to Regence. Open 24 hours a day, 7 days a week. for other plans. State/Alpha Prefix Claims Filing Address Alabama BCBS of Alabama P.O. Media Contact: Audrey Glasby Regence BlueCross BlueShield of Utah Regence . Were proud to stand with you during this challenging time. We must notify you of our decision about your grievance within 30 calendar days after receiving your grievance. Location. Download a form to use to appeal by email, mail or fax. 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: Your provider must submit all clinically relevant information to the plan by phone or fax. | Box 890179 Camp Hill, PA 17089 You must submit prescription drug claims within 12 months of purchase. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) Rev 3/2007 If MAXIMUS disagrees with our decision, we authorize or pay for the requested services within the timeframe outlined by MAXIMUS. To send an electronic claim, use the Availity clearinghouse with payer ID HMA01. % For more information about dual coverage, read the If you have other medical coverage (or UMP High Deductible "If you have other HDHP coverage") section in your plans certificate of coverage. Box 1106Lewiston, ID 83501-1106 Fax: 1 (877) 357-3418 If you have questions about submitting a claim for services outside the U.S., call UMP Customer Service. Regence BlueCross BlueShield of Utah PO Box 1106 Lewiston, Idaho 83501 Or Fax claim to: (888) 606-6582 FORM PD020-UT Page 2 of 3 (Eff. Visit the Regence provider website, regence.com to learn more about: Contact Us View information about who to contact for questions and issues. Be on the lookout for future communications with more information about this exciting enhancement for submitting claim appeals through Availity. Learn more. You cannot ask for a tiering exception for a drug in our Specialty Tier. Management - prior auth/pre-service requests), Email: Members: Log in/register at MyBlue Customer eService, Regence BlueShield - FEPPO Box 21709Seattle, WA 98111. The Regence Operations Trainer I would have two years' experience in operational areas to include customer service, claims, membership and/or delivering training in a matrixed environment or . 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 If additional information is needed, we will send you a request. An appeal is a request from a member, or an authorized representative, to change a decision we have made about: Other matters included in your plan's contract with us or as required by state or federal law, Someone who has insurance through an employer, and any dependents they choose to enroll. 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. Learn more about global periods, modifiers, virtual care, unlisted codes and NCCI bypass modifiers. Phoenix, AZ 85072, Phone:800-562-1011 If services were rendered in New York or Pennsylvania, then use the state-specific file address PDF. Click on your plan, then choose theGrievances & appealscategory on the forms and documents page. Consult theFEP local plan directory to find addresses and telephone numbers for other plans.Note: If the equipment was sent from a DME provider in Washington, refer to thesubmission map to determine where to send your claim for processing. Regence BlueShield of Idaho. Choose an option. . Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. 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 . 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. Make sure you have your Member ID card handy when you call us. Premera Blue Cross Blue Shield of Alaska FEP PO Box 33932 Seattle, WA 98133-0932, Phone:800-562-1011 Some of the limits and restrictions to prescription drug coverage will apply when UMP pays second to another plan. Open 24 hours a day, 7 days a week. People with a hearing or speech disability can contact us using TTY: 711. You will also receive a decision on your appeal within 30 calendar days. 2023 Regence BlueShield. 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. Step 1: Start your internet browser, and then go to the official regence bluecross blueshield of oregon address website. You must submit prescription drug claims within 12 months of purchase. Learn more about global periods, modifiers, virtual care, unlisted codes and NCCI bypass modifiers. 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. View the toolkit Claims submission See your certificate of coverage for more information on how to file a claim for specific services and supplies. Yelp users haven't asked any questions yet about Regence Blue Cross Blue Shield of Oregon. Send your claim or correspondence to the Blue Cross Blue Shield plan in the state from which the durable medical equipment was sent.Example: You live in Seattle and order parts for a wheelchair from a company in Montana. Diabetes. In addition, you cannot obtain a brand-name drug for the copayment that applies to the generic drug. First- and second-level appeals are part of an internal review process, while independent reviews are part of an external review process. 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). Call the phone number on the back of your member ID card. Call customer service and web support at 800-607-0546 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. Were empathetic, reliable and tenacious, too. When a claim for workers compensation is accepted, all services related to that injury or illness are not covered, even if some services are denied by workers compensation. PO Box 52057 Read the "Guidelines for prescription drugs UMP covers" section of your certificate of coverage for details. The Centers for Medicare & Medicaid Services values your feedback and will use it to continue to improve the quality of the Medicare program. Improving Health State-by-State, For the Health of America. Your life. Lastly mail the completed claim form to the address provided. Pre-authorization View services and supplies that require pre-authorization. 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. **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. Subscribe to online communications receive newsletters and important news via email. When UMP pays second to another plan that covers the member, UMP will pay only an amount needed to bring the total benefit up to the amount UMP would have paid if the member did not have another plan. In the left-hand column, locate the state where services were rendered. Information current and approximate as of December 31, 2018. The following information must appear on the provider's itemized bill for the plan to consider the claim for payment: a. Customer Service will help you with the process. Coverage decisionsA coverage decision is a decision we make about what well cover or the amount well pay for your medical services or prescription drugs. Consult theFEP local plan directory to find addresses and telephone numbers for other plans.Note: If the laboratory work was sent to Washington for testing or analysis, refer to theWashington claims submission map to determine where to send your claim for processing. For questions about appeals, call the SEBB Appeals Unit at 1 (800) 351-6827. See Complaints about quality of care in your certificate of coverage to learn more. Join us! Select the area of the map that matches the color of the county where the service was performed. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Espaol | Search jobs. If you have any questions about specific aspects of this information or need clarifications, please email press@bcbsa.com . All features have been transitioned to the Availity Provider Portal. If your coverage changes, call UMP Customer Service and Washington State Rx Services. Don't have your card? View your credentialing status in Payer Spaces on Availity Essentials. A list of reciprocal partners as well as membership benefits can be found at lifeflight.org. 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 Appeal form (PDF): Use this form to make your written appeal. I . Please do not submit attachments (e.g., X-rays, periodontal chartings) with your pretreatment estimate or initial claims submission. There are several levels of appeal, including internal and external appeal levels, which you may follow. When UMP pays second, you must still pay your deductible before UMP pays benefits. You can send your appeal online today through DocuSign. 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. Get help when you need it. Notice will include explanation why an extension is needed and when the plan expects to act on the claim. UMP may cover some supplies through the medical benefit and other supplies under the prescription drug benefit. Submit a Preauthorization Request Need help with a claim? 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 requested, we will supply copies of the relevant records we used to make our initial decision or appeal decision for free. 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. 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. 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 submit feedback about your Medicare health plan or prescription drug plan directly to Medicare. Professional Services are performed by a doctor or other healthcare professional. stream Identify BlueCard members, verify eligibility and submit claims for out-of-area patients. We will notify you if we need more time to respond. Premera Blue Cross If you or your dependents have other insurance, you must let UMP Customer Service and Washington State Rx Services know so claims are paid correctly. 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 more about our payment and dispute (appeals) processes. Step 2: Next, locate the "Login" button at the top-right corner. When we make a decision about what services we will cover or how well pay for them, we let you know. 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). Regence BlueCross BlueShield of Utah is an independent licensee of the Blue Cross and 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. 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. PO Box 1271 MS C7APortland, OR 97207-1271 This form is to be used only for services in Oregon and Clark County, WA. Din kehji k'eyeedgo, t' shdi k anidaalwoi bi bsh bee hane ninaaltsoos bee atah nilinigii bined bik. Availity and Regence Working with Regence online? Please do not submit attachments (e.g., X-rays, periodontal chartings) with your pretreatment estimate or initial claims submission. MAXIMUS Federal Services is a contracted provider hired by the Center for Medicare and Medicaid Services (also known as CMS) and has no affiliation with us. 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 of Oregon offers health and dental coverage to 750,000 members throughout the state. Find helpful phone, fax and email information for assistance. 0. . Follow the steps below to submit your claim online. Para asistencia en espaol, por favor llame al telfono de Servicio al Cliente en la parte de atrs de su tarjeta de miembro. 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. Recommended Reviews. Your budget. Circumstances beyond the plans control. We will ask your permission if we need more time to respond. Send your claim or correspondence to the Blue Cross Blue Shield plan in the state where the ambulance picked up the patient.Example: An ambulance picks up the patient in Oregon and transports her to a care facility in Washington. Please note: This form is to be used by physicians, other professional providers or medical facilities to contact their assigned provider relations representatives. For services outside this area, please contact customer service directly at 1 (800) 365-3155 as your claim will require special handling. While it's a good idea to submit a complaint as soon as possible, there isn't a deadline to do so. Why choose Regence Individual & family plans Regence BlueShield. Information current and approximate as of December 31, 2018. You must continue to use network pharmacies until you are disenrolled from our plan to receive prescription drug coverage under our formulary. Box 1106 Lewiston, ID 83501-1106 Fax: 1 (877) 357-3418 . The plan will decide on your expedited appeal within 72 hours of the request. 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. Stay up to date on what's happening from Salt Lake to St. George. THIS AMENDMENT, effective January 01, 2023, hereby amends the Medical Group Agreement ("Agreement" or as otherwise defined in the Agreement) and any and all amendments, addenda, attachments or exhibits thereto by and between Regence BlueCross BlueShield of Oregon (Regence or as otherwise defined in the Agreement and hereafter referred to as You must appeal within 60 days of getting our written decision. Blue Cross and Blue Shield of Nevada will process the claim. Library Access our Administrative Manual and keep up to date with news. Your provider should supply clinically relevant information, such as medical records for services denied based on medical necessity or for other clinical reasons. Box 999Appleton, WI 54912-0999Fax: 1 (855) 668-8550. <> Coding toolkit View our clinical edits and model claims editing. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. 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. Portugus | Blue Cross and Blue Shield of Montana will process the claim. We will accept verbal expedited appeals. Note: If you submit your claim by mail, be sure to make copies of your documents for your records. complies with applicable Federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation. See what were doing in your community to keep people safe and healthy. Follow the prompts to submit your claim online. complies with applicable Federal and Washington state civil rights laws, Determine the county where the service was performed* (see exceptions below). Coordination of Benefits or Other Party Liability . To obtain information on the aggregate number of grievances, appeals and exceptions filed with the plan contact Customer Service. You receive services from an out-of-network provider. Complete and mail or fax a WSRxS Multiple Pharmacy Coverage Inquiry Form (Drug Coordination of Benefits) to Washington State Rx Services. For information on false claims, see False claims or statements in your certificate of coverage. An appeal is an oral or written request submitted by you or your authorized representative to Regence BlueShield or Washington State Rx Services to reconsider: You or someone you authorize to represent you may request an appeal. Your life. Contact informationMedicare Advantage/Medicare Part D Appeals and GrievancesPO Box 1827, MS B32AGMedford, OR 97501, FAX_Medicare_Appeals_and_Grievances@regence.com, Oral coverage decision requests1 (855) 522-8896, To request or check the status of a redetermination (appeal): 1 (866) 749-0355, Fax numbersAppeals and grievances: 1 (888) 309-8784Prescription coverage decisions: 1 (888) 335-3016. If you do not submit your claims through Availity Essentials, follow this process to submit your claims to us electronically. Chronic Obstructive Pulmonary Disease. See how our affordable Regence plans offer coverage, access and convenienceso you can live your best. 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. BCBS State by State | Blue Cross Blue Shield. 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 UMP medical plans are administered by Regence BlueShield. 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. <> Box 1106Lewiston, ID 83501-1106. Regence BlueShield serves select counties in the state of Washington and is an independent licensee of the Blue Cross and Blue Shield Association. 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. Please include the following information when requesting an appeal: The plan will send confirmation when it receives your appeal. Instructions: 1. The quality of care you received from a provider or facility. PO Box 52080 Appropriate staff members who were not involved in the earlier decision will review the appeal. Other specialized services (home hospice, organ/tissue transplants, and clinical trials). Mail or fax both the claim form and the provider's claim document (or bill) to: Regence BlueShieldAttn: UMP ClaimsP.O. 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. Regence users: make the switch to the Availity Web Portal You have been redirected from the Regence or Asuris Northwest Health Provider Center. 7:00 AM - 6:00 PM PSTFax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals only)Fax: 866-948-8823 (FEP Care Requests to find out if a medical service or procedure is covered. When the plan is the primary payer (pays first), UMP pays its normal benefit as described in the certificate of coverage. Care Management Programs. 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 Management - prior auth/pre-service requests), Members: Log in or register - MyBlue Customer eService, Retail Pharmacy Program PO Box 52057 Phoenix, AZ 85072, Retail Pharmacy Program PO Box 52080 Phoenix, AZ 85072, Phone:800-552-0733Fax: 801-333-6523 (Mark claims: Attn New Claims)Email: Log in or register - MyBlue Customer eService, Regence BlueShield - FEPPO Box 857Lewiston, ID 83501, Regence BlueShield - FEPPO Box 1388Lewiston, ID 83501Customer Service. Polski | 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. You can download the appeal form and submit your written appeal by fax or mail: Mail:WSRxS We're ready. Get Marvin Thomas's email address (m*****@regence.com) and phone number (253581..) at RocketReach. 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). If your primary plan uses a different mail-order pharmacy, you will have to use your primary plans mail order pharmacy and then submit a claim to Washington State Rx Services. 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. endobj As one of the state's largest health insurers, Regence BlueCross BlueShield of Oregon is committed to addressing current and emerging health needs for the nearly one million Oregonians we serve. You can submit a marketing complaint to us by calling the phone number on the back of your member ID card or by calling 1-800-MEDICARE (1-800-633-4227). Regency Blue Cross Blue Shield Of Oregon (541) 772-8906 Visit Website Map & Directions 2057 Commerce Dr Medford, OR 97504 Write a Review. If you do not obtain your physician's support, we will decide if your health condition requires a fast decision. TRS: 711Business hours: Monday through Friday 8 a.m. to 4:30 p.m. (Pacific). Regence BlueCross BlueShield of Utah Step 3: Next, enter your Username/Password in the appropriate fields. We know it is essential for you to receive payment promptly. | Claims payment, processing, or reimbursement for health care services or supplies. All from Regence, a company committed to service, community and this place we call home. Allied professionals, including behavioral health, vision, chiropractic and other complementary service providers: Contact your allied provider relations representatives & consultants. When you use a network provider or network pharmacy, you dont need to submit a claimthe provider or pharmacy will do it for you. This is the customer service number for questions about your health insurance coverage, benefits or treatment. 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. 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. TTY/TDD users can call 1-877-486-2048, 24 hours a day/7 days a week. If you want a written response, you must request one. Sign in to your Regence account. View our clinical edits and model claims editing.
