Uniform Medical Claim Form

Uniform Medical Plan (UMP) - Washington

https://www.hca.wa.gov/about-hca/programs-and-initiatives/uniform-medical-plan-ump

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 …

How the UB-04 Form Is Used to Bill Insurance …

https://www.verywellhealth.com/preparing-the-ub-04-form-2317061

Uniform Medical Plan - Regence

https://www.regence.com/provider/products/large-groups-administrators/ump

Uniform Medical Plan (UMP) is a health plan offered through the Washington State Health Care Authority’s (HCA) Public Employees Benefits Board (PEBB) and the School …

MEDICAL CLAIM FORM - Washington

https://www.hca.wa.gov/assets/pebb/ump-regence-medical-claim-form.pdf

MEDICAL CLAIM FORM Use this form to submit reimbursement requests for services received from a non-network provider. Please complete a separate form for each family …

Claims - PEBB - Regence

https://ump.regence.com/pebb/benefits/claims-appeals

Submit a claim by mail or fax Mail or fax both the claim form and the provider's claim document (or bill) to: Regence BlueShield Attn: UMP Claims P.O. Box 1106 Lewiston, ID …

Uniform Medical Plan (UMP) | Washington State Health …

https://www.hca.wa.gov/employee-retiree-benefits/school-employees/uniform-medical-plan-ump

With the Uniform Medical Plan, you may choose from the plans listed below. Remember, if you cover eligible dependents, everyone must enroll in the same medical plan. Learn …

HEALTH INSURANCE CLAIM FORM - DOL

https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-1500.pdf

HEALTH INSURANCE CLAIM FORM APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE. MEDICARE (Medicare#) MEDICAID (Medicaid#) TRICARE (ID#/DoD#) …

Forms and documents for members - Regence

https://www.regence.com/member/resources/forms-documents

Forms and Documents for Individuals and Families Access all the forms and documents you need to manage your health plan—from claims forms to health information …

Forms and documents - Regence

https://www.regence.com/provider/forms-documents

Forms and documents Forms & documents for providers Access all the forms and documents you need to support your Regence patients, manage your claims payments …

Institutional paper claim form (CMS-1450) | CMS

https://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/15_1450

The CMS-1450 form (aka UB-04 at present) can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver …