Uniform Medical Claim Forms

Uniform Medical Plan (UMP) - Washington

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

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 …

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 preferred provider health plan managed by the Washington State Health Care Authority (HCA) through the Public Employees Benefits …

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#) …

Uniform Medical Plan (UMP) | Washington State Health …

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

UMP administered by Regence BlueShield (Medical only) (UMP Achieve 1, UMP Achieve 2, UMP High Deductible, UMP Plus) Online: Uniform Medical Plan for school employees …

MEDICAL CLAIM FORM - Washington

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

used for claims for PEBB and SEBB Uniform Medical Plans. Network providers will submit claims to Regence directly. 1. ... Sign the completed form where indicated at the bottom …

Claims - PEBB - Regence

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

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 83501-1106 Fax: 1 (877) 357 …

Commonly used forms - PEBB

https://ump.regence.com/pebb/forms/common-forms

Medical Reimbursement Claim form: for services received from an out-of-network provider or if you have other insurance that pays first and UMP is secondary (see How to submit a …

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

Find forms to request pre-authorization, care management or appeals, or direct overpayment recovery. Download and print helpful material for your office. ... Access all …