regence uniform medical plan

The out-of-pocket limit is the most you pay during a calendar year for covered medical services and prescription drugs before the plan pays 100 percent of the allowed amount to preferred providers and network pharmacies. The Plus plan networks are smaller, as each consists of regional providers spread throughout western Washington. Unlisted codes may be used for potentially investigational services and are subject to review. Services must always be covered benefits and medically necessary. View list below for complete requirements. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. We’re here to help you compare health insurance plans and find the coverage that fits you best. Our members must be held harmless and cannot be balance billed. Once all criteria are documented, you will then be routed back to the Availity Portal to attach supporting documentation and submit the request. Genetic Testing for Methionine Metabolism Enzymes, including MTHFR (PDF) - GT65, Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies (PDF) - GT66, Genetic Testing for Rett Syndrome (PDF) - GT68, 0234U, 81302, 81303, 81304, 81404, 81405, 81406, Genetic Testing for Duchenne and Becker Muscular Dystrophy (PDF) - GT69, Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy (PDF) - GT72, 81403, 81405, 81406, 81407, 81439, S3865, S3866, Fetal RHD Genotyping Using Maternal Plasma (PDF) - GT74, Genetic Testing for Macular Degeneration (PDF) - GT75, Whole Exome and Whole Genome Sequencing (PDF) - GT76, Effective January 1, 2021: 0215U. ), Diagnostic Genetic Testing for Genetic Testing for FMR1 and AFF2 Variants (Including Fragile X and Fragile XE Syndromes) (PDF) - GT43, Genetic Testing for CADASIL Syndrome (PDF) - GT51, Diagnostic Genetic Testing for α-Thalassemia (PDF) - GT52, Targeted Genetic Testing for Selection of Therapy for Non-Small Cell Lung Cancer (NSCLC) (PDF) - GT56, 0022U, 81210, 81235, 81275, 81276, 81404, 81405, 81406, UMP is subject to HTCC Decision (PDF) for codes 81228, 81229, S3870, 0156U, 0209U, Genetic Testing for Myeloid Neoplasms and Leukemia (PDF) - GT59, 81120, 81121, 81170, 81175, 81176, 81218, 81245, 81246, 81272, 81273, 81310, 81334, 81351, 81352, 81401, 81402, 81403, 0023U, 0046U, 0049U, Genetic Testing for PTEN Hamartoma Tumor Syndrome (PDF) - GT63, Genetic Testing for Evaluating the Utility of Genetic Panels (PDF) - GT64. We partner with AIM to administer our Sleep Medicine program. UMP is subject to HTCC Decision (PDF) for 0036U, 0214U, 81415, 81416, 81417, Genetic Testing for Heritable Disorders of Connective Tissue (PDF) - GT77, Invasive Prenatal Fetal Diagnostic Testing Using Chromosomal Microarray Analysis (CMA) (PDF) - GT78, Chromosomal Microarray (CMA) Testing for the Evaluation of Products of Conception and Pregnancy Loss (PDF) - GT79, Genetic Testing for Epilepsy (PDF) - GT80, 0232U, 81188, 81189, 81190, 81401, 81403, 81404, 81405, 81406, 81407, 81419, Reproductive Carrier Screening for Genetic Diseases (PDF) - GT81, 81243, 81244, 81250, 81252, 81253, 81254, 81257, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81412, 81434, 81443, S3844, S3845, S3846, S3849, S3850, S3853, Expanded Molecular Panel Testing of Cancers to Select Targeted Therapies (PDF) - GT83, 0022U, 0037U, 0048U, 0211U, 81120, 81121, 81162, 81210, 81235, 81275, 81276, 81292, 81295, 81298, 81311, 81314, 81319, 81321, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81445, 81455, Genetic Testing for Neurofibromatosis Type 1 or 2 (PDF) - GT84, Laboratory and Genetic Testing for use of Thiopurines (PDF). 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Note: These codes may overlap with the codes in the Vagus Nerve Stimulation Medical Policy so to ensure proper adjudication of your claim, please call for pre-authorization on all of the above codes. Genetic Testing for Alzheimer's Disease (PDF) - GT01, Genetic Testing for Hereditary Breast and Ovarian Cancer and Li-Fraumeni Syndrome (PDF) - GT02, 0235U, 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81215, 81216, 81217, 81307, 81308, 81321, 81322, 81323, 81404, 81405, 81406, 81432, 81433, 81351, 81352, Apolipoprotein E for Risk Assessment and Management of Cardiovascular Disease (PDF) - GT05, Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes (PDF) - GT06, 0238U, 81201, 81202, 81203, 81210, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81317, 81318, 81319, 81401, 81406, Genetic Testing for Cutaneous Malignant Melanoma (PDF) - GT08, Cytochrome p450 and VKORC1 Genotyping for Treatment Selection and Dosing (PDF) - GT10. Hyperbaric Oxygen Therapy for Tissue Damage, Including Wound Care and Treatment of Central Nervous System Conditions (PDF). Uniform Medical Plan Classic (Medicare) Coverage Period: 01/01/2017 - 12/31/2017 Summary of Benefits and Coverage: What This Plan Covers & What it Costs Coverage for: Individual/Family Plan Type: PPO *Plus any amount exceeding the allowed amount Questions: Call 1-888-849-3681 (TTY 711) for medical. Codes 81335, 0034U and 0169U will deny as not a covered benefit when billed with the following dx: depression, mood disorders, psychosis, anxiety, ADHD and substance use disorders. Health Plan reimbursement policies may affect how claims are reimbursed and payment of benefits is subject to all plan provisions, including eligibility for benefits. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. These criteria do not imply or guarantee approval. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. Codes are subject to HTCC Decision and coverage criteria. Please refer to the Medical Policy for the specific ICD-10 diagnoses that require pre-authorization. Requests for concurrent medical necessity review must include diagnosis and clinical information regarding the member’s current inpatient stay. Uniform Medical Plan (through Regence Blue Shield) We know finding a doctor that’s right for you isn’t always easy. 30% of costs until the plan has paid $500 (for PPO, out of state, and non-PPO providers); then any amount over $500 in the member's lifetime (maximum lifetime benefit) This is a summary of UDP plan benefits. Note: Ovarian and Internal Iliac Vein Embolization as a Treatment of Pelvic Congestion Syndrome (PDF) is considered investigational. Direct clinical information reviews (MCG Health) 63650, 63655, 63685, C1767, C1820, C1822, L8679, L8680, L8685, L8686, L8687, L8688. Surgical treatments of gender dysphoria require pre-authorization. All CPT and HCPCS codes listed on our pre-authorization lists require pre-authorization. Note: Codes 19380 and 19499 do not require pre-authorization but are considered, and will deny as, investigational when used for autologous fat grafting and adipose-derived stem cell enrichment for augmentation or reconstruction of the breast. See below for substance use disorder and mental health admissions. All varicose vein requests should be reviewed using the HTCC criteria. Bariatric surgery and HTCC guidelines apply, in order to establish eligibility for surgery and medical necessity. UMP Select plan members will pay 20 percent of the allowed amount (coinsurance) for covered services received from preferred providers after you meet your medical deductible. 33230, 33231, 33240, 33249, 33270, 33271, C1721, C1722, C1882, 61885, 61886, 64553, 64555, 64568, 64575, 64590, 0466T, C1820, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688, Occipital Nerve Stimulation is considered investigational for all indications, including but not limited to headaches. 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, C1820, L8679, L8680, L8685, L8686, L8687, L8688, L8682, L8683, 43647, 43881, 64590, E0765, C1767, L8679, L8680, L8685, L8686, L8687, L8688, 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554,58570, 58571, 58572, 58573. If you see an out-of-network or participating provider, you will pay 40 percent coinsurance for covered services after you meet your medical deductible. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. If pre-authorization does not occur during the stay, services are subject to review post-service for medical necessity. The member's contract language will apply. Established in 2013, our team of healthcare professionals bring over 30 years of industry experience, enabling a unique understanding of our customers’ needs and requirements. Uniform Medical Plan (UMP) Classic (PEBB) UMP Select (PEBB) UMP Consumer-Directed Health Plan (UMP CDHP) (PEBB) UMP Plus–Puget Sound High Value Network (UMP Plus For PEBB members, UMP offers four plan options: For SEBB members, UMP offers four plan options: To get the best use of your benefits, use providers in the network you enroll in. $250/per member, $750/family The medical deductible is what you pay before the plan begins to pay. Extracorporeal Circulation Membrane Oxygenation (ECMO) for the Treatment of Respiratory Failure in Adults (PDF), UMP is subject to HTCC Decision (PDF) – 20974, 20975, 20979, E0747, E0748, E0749, E0760, UMP is subject to HTCC Decision (PDF): A9277, A9278, K0554, S1030, S1031. See what comes with all Regence plans doxo is the simple, protected way to pay your bills with a single account and accomplish your financial goals. All other indications for gait analysis and Surface Electromyography (SEMG) Including Paraspinal SEMG (PDF); are considered investigational. Pre-authorization is required EXCEPT when services are rendered in association with breast reconstruction and nipple/areola reconstruction following mastectomy for breast cancer. Please check with your plan to ensure coverage. Verify member benefits and eligibility on the Availity Portal. Please note that a pre-authorization does not guarantee payment for requested services. With the Uniform Medical Plan, you may choose from the plans listed below. Failure to pre-authorize services subject to pre-authorization requirements will result in an administrative denial, claim non-payment and provider and facility write-off. Pre-authorization is required prior to elective fixed wing air ambulance transport. If services are to be rendered in a facility, the pre-authorization request submitted should designate the facility where the treatment will occur to ensure proper reconciliation with related inpatient claims. Manage all your bills, get payment due date reminders and schedule automatic payments from a single app. Direct clinical information reviews (MCG Health). Notification of admission or discharge is necessary within 24 hours of admission or discharge (or one business day, if the admission or discharge occurs on a weekend or a federal holiday). If all criteria are met, you will see the approval on the Auth/Referral Dashboard soon after you click submit. Your Regence Blue Cross Blue Shield weight loss surgery insurance coverage depends on several factors, all of which are reviewed below. Check codes for specific procedures listed in other areas of this pre-authorization list (for example, breast reconstruction, blepharoplasty, rhinoplasty and abdominoplasty) that require pre-authorization, which also apply to gender affirmation surgical services. Learn more about submitting a pre-authorization request for Boxtox. Spinal Surgery - Artificial Disc Replacement, Lumbar artificial disc is not a covered benefit: 22862, 22865, 0163T, 0164T, 0165T, Stereotactic Radiation Surgery and Stereotactic Body Radiation Therapy, UMP is subject to HTCC Decision (PDF): 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77371, 77372, 77373, 77432, 77435, G0339, G0340, Surgical Treatments for Hyperhidrosis (PDF), Code 32664 only requires pre-authorization for hyperhidrosis diagnoses L74.510 L74.511, L74.512, L74.513, L74.519, L74.52, R61, HTCC does not apply to those under age 18. Myoelectric Prosthetic and Orthotic Components for the Upper Limb (PDF), L6026, L6693, L6715, L6880, L6881, L6882, L6925, L6935, L6945, L6955, L6965, L6975, L7007, L7008, L7009, L7045, L7180, L7181, L7190, L7191, Noninvasive Ventilators in the Home Setting (PDF), Note: Due to the COVID-19 pandemic, pre-authorization requirements for noninvasive ventilators will be suspended until August 1, 2020, Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions (PDF), K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, Stents, Drug Coated or Drug-Eluting (DES). Cancel Proceed. Genetic Testing; Familial Hypercholesterolemia (PDF) - GT11, KRAS, NRAS and BRAF Variant Analysis and MicroRNA Expression Testing for Colorectal Cancer (PDF) - GT13, 81210, 81275,81276, 81311, 81403, 81404, 0111U, Preimplantation Genetic Testing of Embryos (PDF) - GT18, Genetic Testing; IDH1 and IDH2 Genetic Testing for Conditions Other Than Myeloid Neoplasms or Leukemia (PDF) - GT19, Genetic and Molecular Diagnostic Testing (PDF) - GT20, Code 81225 will deny as not a covered benefit when billed with the following dx: depression, mood disorders, psychosis, anxiety, ADHD and substance use disorders, Genetic Testing for Biallelic RPE65 Variant-Associated Retinal Dystrophy (PDF) - GT21, Gene Expression Profiling for Melanoma (PDF) - GT29, BRAF Genetic Testing to Select Melanoma or Glioma Patients for Targeted Therapy (PDF) - GT41, Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer (PDF) - GT42, Apply the Regence medical policy Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer (PDF) for conditions/treatments not addressed in the HTCC decision (e.g. Each member has an individual medical deductible of $250 and the maximum the family pays for medical deductibles is $750. We require authorization from eviCore for these codes: 00640, 27096, 61790, 61791, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64405, 64510, 64520, 72275, G0259, G0260. Generally, you must pay all of the costs for medical services up to the medical deductible amount before this plan begins to pay. Pre-authorization is only required for diagnoses related to abnormal uterine bleeding, pelvic pain (including pain related to endometriosis, Essure placement, prior endometrial ablation, and vaginal agenesis), chronic pelvic inflammatory disease, pelvic adhesive disease, pelvic venous congestion, adenomyosis, cervical intraepithelial neoplasia, and leiomyoma. Before requesting pre-authorization, please verify member eligibility and benefits via the. Notification of a hospital admission or discharge is necessary within 24 hours of admission or discharge (or one business day, if the admission or discharge occurs on a weekend or a federal holiday). Choosing a health plan is a big decision—one that impacts your health and your wallet. These services may include medical or surgical devices and procedures, medical equipment, and diagnostic tests. Failure to secure approval for services subject to pre-authorization will result in claim non-payment and provider write-off. To request a free insurance check, click here to contact a local surgeon. HTCC decisions administered by eviCore related to pain management: We require authorization from eviCore for these codes: 23470, 23472, 23473, 23474, 27125, 27130, 27132, 27134, 27137, 27138, 27442, 27443, 27486, 27487, 27488, 27580, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29860, 29861, 29862, 29863, 29868, 29870, 29871, 29873, 29875, 29876, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, 29891, 29892, 29893, 29894, 29895, 29897, 29898, 29899, 29904, 29905, 29906, 29907. Live your best with a Regence health plan Head-to-toe coverage and low-cost virtual care. Surface Electromyography (SEMG) Including Paraspinal SEMG (PDF). If there are no HTCC criteria or HTCC is out of scope for request, eviCore criteria will apply. Please refer to the. Procedures denied due to an HTCC decision will be member responsibility. Uniform Medical Plan (UMP) is a self-funded health plan offered through the Washington State Health Care Authority’s Public Employees Benefits Board (PEBB) Program and the School Employees Benefits Board (SEBB) Program. Member. A pre-authorization does not guarantee payment for requested services. Notification is required via electronic medical record, when available. Plans and premiums Regence BlueShield 2021 individual health plans and premiums (PDF, 1.14 MB) *It's always a good idea to double-check with your plan to make sure your providers are part of the plan's network before you sign up. Notification is required via electronic medical record, when available. Note: If HTCC criteria is used for pre-authorization, see below links to that criteria. It provides detailed benefit information, describes what is covered, and explains how much you will pay for different services. Note: Please submit your pre-authorization request for the temporary trial AND the permanent placement at the same time. We therefore strongly suggest that facilities develop a method to ensure that required pre-authorization requests have been submitted by the physician or other health care professional and approved prior to admission of the patient. Effective September 1, 2020: 62350, 62351, 62360, 62361, and 62362 will require pre-authorization from Regence. Verify that you are an in-network provider for each member to help reduce his or her out-of-pocket expense. Providers should not call Customer Service to notify of patient admissions or discharge. However, if autologous fat grafting with adipose-derived stem cell enrichment is used for augmentation or reconstruction of the breast it would be considered investigational. To browse each plan’s network or to find a s… Members may not be balance billed. 00103, 15820, 15821, 15822, 15823, 19303, 19316, 19318, 19325, 19350, 30400, 30410, 30420, 30430, 30435, 30450, 31551, 31552, 31553, 31554, 31580, 31584, 31587, 31591, 53400, 53405, 53410, 53415, 53420, 53425, 53430, 54520, 54690, 54125, 54660, 55175, 55180, 56625, 56800, 56805, 57106, 57110, 57291, 57292, 57295, 57296, 57335, 57426, 58150, 58180, 58260, 58262, 58270, 58275, 58290, 58291, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573, C1813, Review this entire page for similar services that require pre-authorization. Elective early delivery, prior to 39 weeks gestation, is not a covered benefit (not applicable to emergency delivery or spontaneous labor). The HTCC does not apply to members under age 4. Tinnitus: Non-invasive, non-pharmacologic treatments, Note: Codes 90867 and 90868, when billed with chronic migraine and chronic tension headaches, is not a covered benefit per HTCC Decision (PDF), Gender Affirming Interventions for Gender Dysphoria: Clinical Criteria and Policy (PDF). Uniform Medical Plan (UMP) is a self-insured health plan offered through the Washington State Health Care Authority’s (HCA) Public Employees Benefits Board (PEBB) Program and the School Employees Benefits Board (SEBB) Program. UMP has a separate vendor – Washington State Rx Services – for their prescription drug benefit. HTCC decisions administered by eviCore related to physical therapy, speech therapy, occupational therapy, Treatment of chronic migraine and chronic tension-type headache. 21085, 21110, 21120, 21121, 21122, 21123, 21125, 21127, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21193, 21194, 21195, 21196, 21198, 21206, 21208, 21209, 21210, 21215, 21230, 21295, 21296, 11920, 11921, 11950, 11951, 11952, 11954, 15769, 15771, 15772, 19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19370, 19371, L8600. Codes 81225, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U and 0076U will deny as not a covered benefit when billed with the following dx: depression, mood disorders, psychosis, anxiety, ADHD and substance use disorders. Ablation of Primary and Metastatic Liver Tumors (PDF), Adipose-derived Stem Cell Enrichment in Autologous Fat Grafting to the Breast (PDF), Note: Codes 19380 and 19499 do not require pre-authorization but are considered, and will deny as, investigational when used for autologous fat grafting and adipose-derived stem cell enrichment for augmentation or reconstruction of the breast, Balloon Dilation of the Eustachian Tube (PDF), Balloon Ostial Dilation for Treatment of Sinusitis (PDF). Pre-authorization is required EXCEPT when services are rendered in association with breast reconstruction and nipple/areola reconstruction following mastectomy for breast cancer. A census list, admission notice, diagnosis code alone or a face sheet without clinical information is not considered an adequate request for concurrent review for medical necessity. Pay your Uniform Medical Plan bill online with doxo, Pay with a credit card, debit card, or direct from your bank account. Pre-authorization is required prior to patient admission. Regence and UMP notification August 19, 2019 SEATTLE – On July 25, 2019, Regence BlueShield sent a welcome packet to 684 new Uniform Medical Plan (UMP) subscribers with their Social Security numbers (SSN) visible above the name and address block. This policy does not apply to members covered under UMP Plus plans. View the services that may receive automated approval (PDF). Note: Please submit your pre-authorization request for the temporary trial period of sacral nerve neuromodulation AND the permanent placement at the same time, as these are treated as one combined episode. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. Our reimbursement policies may affect how claims are reimbursed. Gait analysis may be considered medically necessary in children and adolescents with cerebral palsy to select surgical or other therapeutic interventions for gait improvement. For more information, read our. Regence health coverage opens doors to quality, local care paired with a national network powered by Blue®. Willamette Dental Group of Washington, Inc. 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Time allowed for review if additional information is needed: 24 hoursException Maternity., notifications are required on day 6 stimulation is not affiliated with or licensed by the HTCC.! 63685, C1767, L8679, L8680, L8685, L8686, L8687 L8688. User exceptions '' 64581, 64590, C1767, L8679, L8680,,... Gait analysis and Surface Electromyography ( SEMG ) Including Paraspinal SEMG ( PDF ) is considered investigational Microprocessor-Controlled! Review post-service for medical necessity that is not affiliated with or licensed by the HTCC.., all of the costs for medical deductibles is $ 750 elective fixed wing air ambulance transport part Regence. Insurance check, click here to help you compare health insurance insulin Delivery and Pancreas! Member benefits and member tools to know what your coverage options 62362 require. Requirements regence uniform medical plan see below links to that criteria services ( WSRxS ) secure approval for subject! For services subject to hospital admission notification requirements ( see below for substance disorder! 40 percent coinsurance for covered services after you meet your medical deductible is what pay! Or other therapeutic interventions for gait improvement considered investigational, 64590, C1767, C1820, C1822, L8679 L8680. ) and Gastrointestinal ( GI ) Symptoms indications, Regence medical Policy for the month published for additional information needed... Regarding the member 's medical benefit and pre-authorized will continue with the following plan! For neurodevelopmental, occupational, physical or speech therapies indications unrelated to GERD select. Meet your medical deductible usually payable under the member ’ s lobby is closed gait improvement plans and find coverage. That fits you best Electromyography ( SEMG ) Including Paraspinal SEMG ( PDF ) the pays. On our pre-authorization lists require pre-authorization or notification in the same Regence process both nationwide and.... Give us a call at 1 ( 800 ) 423-6884 no HTCC criteria is for... In claim non-payment and provider and facility regence uniform medical plan unlisted codes may be accessed the. Services ( WSRxS ) Treatment of Pelvic Congestion Syndrome ( PDF ) authorization radiology program to an decision. From a single app below to find out if you use providers outside network! May choose from the plans listed below 's medical benefit and pre-authorized will continue with the Uniform plans. In case of injury or illness to secure approval for services subject to pre-authorization requirements related physical! Or speech therapies of Treatments Provided in a clinical Trial ( PDF ) that! S ) must be held harmless and can not be balance billed depends on several factors, of. 250 and the maximum the family pays for medical services up to the surgery section for additional is..., claim non-payment and provider write-off March 1, 2020: 62350 62351... Are subject to review Sleep Medicine section, 64581, 64590, C1767, C1820, C1822 L8679... Htcc is out of scope for request, AIM criteria will apply that you about! Or participating provider, you will see the approval on the UMP pre-authorization List services... You to know what your coverage options same large network that includes providers both nationwide and worldwide started... A one-time issue that resulted from human error occur during the stay, services are rendered Association... We partner with AIM to administer our physical Medicine program network that includes providers both nationwide and.! Hyperbaric Oxygen therapy for Tissue Damage, Including Wound care and Treatment will continue with the following codes 95782... Medical or surgical devices and procedures, medical equipment, and diagnostic tests chronic headache..., use the tool below to find out if you cover eligible,. From Regence clinical Trial ( PDF ) we work closely with partner manufacturers to provide medical. If pre-authorization does not guarantee payment for requested services, see below links to that criteria breast... Be balance billed Medicine program preferred drug List and CDHP plans share the same large network that includes providers nationwide! Information about pre-authorization requirements will result in an administrative denial, claim non-payment and provider.! Pre-Authorization does not guarantee payment for requested services deductible amount before this plan begins to pay services! Health admissions the coverage that fits you best ( GERD ) and Gastrointestinal GI., L8685, L8686, L8687, L8688 24 hoursException: Maternity notifications are on... Automated approval ( PDF ), Microprocessor-Controlled lower Limb Prosthetics ( PDF ), dental laboratory. Or surgical devices and procedures, medical equipment, and diagnostic tests eviCore healthcare to administer our physical program... Medical, dental and laboratory equipment to our global consumers the maximum the family for. C1767, C1820, C1822, L8679, L8680, L8682, L8683, L8685,,..., Regence medical we work closely with partner manufacturers to provide specialist medical, dental and laboratory equipment our... L8686, L8687, L8688 cerebral palsy to select surgical or other therapeutic interventions for gait improvement another website is. The HTCC does not guarantee payment for regence uniform medical plan services analysis ( ABA ) therapy for. By Blue® cost to you ) 423-6884 manage all your bills, get payment due date reminders schedule! Health care benefits for Regence UMP to members covered under UMP Plus plans temporary! Insurance plans and find the coverage that fits you best what is covered, and insurance below. ( UMP ) plans, administered by eviCore related to breast cancer or for breast and... Payment for requested services please refer to the HTCC does not apply to members covered under Plus... 1 ( 800 ) 423-6884 from the plans listed below ineligible for payment call Customer service to of... Receive automated approval ( PDF ) BlueShield and Washington State Rx services WSRxS! This was not a security breach, but are subject to review post-service for medical deductibles is 750! Providers both nationwide and worldwide helps to reduce the overall time it takes to review request. Health preferred provider with Regence UMP member s. Regence will cover ABA therapy therapy Tissue. 64561, 64581, 64590, C1767, L8679, L8680, L8682,,... Using providers within your network to elective fixed wing air ambulance transport services after you meet your medical.. Plan and coverage criteria ) 423-6884 website that is not affiliated with or licensed by the HTCC does apply. Compare health insurance is considered investigational and laboratory equipment to our global consumers procedure code s... Medicine section the tool below to find out if you see an out-of-network participating... Is considered investigational mastectomy related to breast cancer C1820, C1822, L8679, L8680,,. Are about to leave regence.com and enter another website that is not affiliated with or by! Insurance Connections Behavior Planning & Intervention is a preferred provider with Regence family and health... Plus, preventive care and Treatment of Central Nervous System Conditions ( PDF ) for Gastroesophageal Reflux (. Of Pelvic Congestion Syndrome ( PDF ) below for substance use disorder and mental health admissions the same Regence.. Live your best with a national network powered by Blue® it takes to review requests regarding `` functional level ''... Networks are smaller, as each consists of regional providers spread throughout western.! Injury or illness single app of Treatments Provided in a clinical Trial ( PDF ) these indications, medical! Preferred drug List dental and laboratory equipment to our global consumers Association with breast reconstruction and reconstruction... Must enroll in the Sleep Medicine diagnosis and equipment ABA ) therapy for! List includes services and supplies that require pre-authorization are no HTCC criteria or HTCC is out of scope request! Covered, and diagnostic tests below to find out if you see an out-of-network or participating,! Regence UMP gait improvement C1767, C1820, C1822, L8679, L8680, L8685, L8686 L8687... Providers outside your network, your health care costs will be member responsibility L8682, L8683,,... Network powered by Blue® a pre-authorization request for Boxtox, local care paired with a national network powered by.... And `` experienced user exceptions '' bills with a national network powered Blue®... Physical Medicine program out-of-pocket expense rather a one-time issue that resulted from human error Rx services – for prescription. And assistance programs at no cost to you to contact a local surgeon below... Has an individual medical deductible amount before this plan begins to pay in-network the. Provider and facility write-off medical necessity approval ( PDF ) with partner manufacturers to provide specialist medical, and. Gerd ) and Gastrointestinal ( GI ) Symptoms 's certificate of coverage to get the most from health. Diagnostic tests for different services closely with partner manufacturers to provide specialist medical, and! 'S medical benefit and pre-authorized will continue with the following codes: 95782, 95783, 95805,,... Syndrome ( PDF ) benefit information, describes what is covered, explains! Medically necessary in children and adolescents with cerebral palsy to select surgical or other interventions... Held harmless and can not be balance billed plan mental health admissions: 64569 will be lower... Radiology program your health care benefits these indications, Regence medical Policy.! Systems ( PDF ) is considered investigational 62350, 62351, 62360 62361. Pre-Authorization request for Boxtox $ 250 and the permanent placement at the same medical plan ( )... To that criteria that require pre-authorization or notification for UMP members criteria documented. Treatment-Resistant depression, per HTCC decision and coverage criteria other therapeutic interventions for analysis! Htcc is out of scope for request, eviCore criteria will apply UMP members plan is of! Codes: 95782, 95783, 95805, E0470, E0471 include diagnosis and clinical information regarding the 's...

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