regence uniform medical plan
The HTCC does not apply to members under age 4. Due to COVID-19, HCA’s lobby is closed. 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. Gait analysis may be considered medically necessary in children and adolescents with cerebral palsy to select surgical or other therapeutic interventions for gait improvement. 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). Visit Forms & publications and select “UMP” in the Plan search filter for information you need to understand your coverage, including monthly premium amounts and comparisons of UMP plans. At Regence Medical we work closely with partner manufacturers to provide specialist medical, dental and laboratory equipment to our global consumers. Remember, if you cover eligible dependents, everyone must enroll in the same medical plan. Regence medical policy is used only to determine units of treatment, criteria for diabetic "standard wound therapy" and to address any conditions not addressed in the HTCC decisions under the HTCC "limitations of coverage" or "non-covered indicators". Providers should not call Customer Service to notify of patient admissions or discharge. 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. Uniform Medical Plan is part of Regence Blue Cross Blue Shield. Please refer to the. The Classic and CDHP plans share the same large network that includes providers both nationwide and worldwide. 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. Pre-authorization is required prior to elective fixed wing air ambulance transport. If treatment is for other than this indication, Regence medical policy applies. Regence health coverage opens doors to quality, local care paired with a national network powered by Blue®. Counseling for Success is a Uniform Medical Plan mental health preferred provider (PPO). Effective September 1, 2020: 62350, 62351, 62360, 62361, and 62362 will require pre-authorization from Regence. UMP is administered by Regence … 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. See what comes with all Regence plans Choosing a health plan is a big decision—one that impacts your health and your wallet. Learn more about this requirement. The medical deductible is what you pay before the plan begins to pay. For more information, read our. 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. Contact AIM to obtain an order number for the following codes: 95782, 95783, 95805, E0470, E0471. Codes are subject to HTCC Decision and coverage criteria. Generally, you must pay all of the costs for medical services up to the medical deductible amount before this plan begins to pay. UMP is administered by Regence BlueShield and Washington State Rx Services. 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. By using providers within your network, your health care costs will be significantly lower than if you use providers outside your network. 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. Blepharoplasty, Repair of Blepharoptosis, and Brow Ptosis Repair (PDF), 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67950, Pre-authorization is not required for members being treated for a condition other than stable angina, UMP is subject to HTCC Decision (PDF): 37215, 37216, 37217, 37246, 37247, Catheter Ablation Procedures for Supraventricular Tachyarrhythmias (SVTA), UMP is subject to HTCC Decision (PDF): 93653, 93655, 93656, 93657, Cosmetic and Reconstructive Surgery (PDF), Cryosurgical Ablation of Miscellaneous Solid Organ, Pulmonary, and Breast Tumors (PDF), Effective March 1, 2021: Policy title will be changed to "Cryosurgical Ablation of Micellaneous Solid Tumors Outside of the Liver". Regence Uniform Medical Plan (UMP) Insurance Connections Behavior Planning & Intervention is a preferred provider with Regence UMP. Note: Codes 43201 and 43236 may also be used for the administration of Botox for indications unrelated to GERD. Please note that a pre-authorization does not guarantee payment for requested services. Spinal cord stimulation for the treatment of chronic neuropathic pain is not a covered benefit, per, Codes 21145, 21196, 21198, 41120, 42160 do not require pre-authorization when the procedure is performed for oral cancer dx codes: C01, C02-C02.9, C03-C03.9, C04-C04.9, C05-C05.9, C06, C06.2-C06.9, C09-C09.9, C10-C10.0, C41-C41.1, C46.2, D00-D00.00, D10, D10.1-D10.9, D16.4-D16.5, D37-D37.0, D49-D49.0, Upper Endoscopy for GERD and GI Symptoms for UMP members are subject to, CPT 43200, 43202, 43235, 43237, 43238, 43239, 43242 and 43259 do not require pre-authorization, but may be subject to, Attestation forms may be submitted with the claim, or attestation may be completed pre-service through the, Attestation form is required for claims processing, Attestation form is required for adults only (member 18 years and older), 61885, 61886, 64553, 64568, C1822, 0466T, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688, 0466T will continue to be reviewed by Regence Medical Policy. Uniform Medical Plan (UMP) is a collection of high-quality, self-insured preferred provider organization (PPO) health plans and accountable care plans offered through Washington State’s Public Employees Benefits Board (PEBB) Program. For members. Refer to Cardiac Stenting in the Surgery section below. Please use Regence Medical Policy for requests for members under age 4. With the Uniform Medical Plan, you may choose from the plans listed below. UMP is designed to keep you and your family healthy, as well as provide benefits in case of injury or illness. 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. 43279, 43280, 43281, 43282, 43325, 43327, 43328, 43332, 43333, 43334, 43335, 43336, 43337, Hysterectomy procedures for the indication of gender dysphoria are subject to the Gender Affirming Interventions for Gender Dysphoria: Clinical Criteria and Policy (PDF), Pre-authorization is required EXCEPT when the member is age 17 or younger, Implantable Peripheral Nerve Stimulation for Chronic Pain of Peripheral Nerve Origin (PDF), Laser Treatment for Port Wine Stains (PDF), Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation (PDF), Magnetic Resonance (MR) Guided Focused Ultrasound (MRgFUS) and High Intensity Focused Ultrasound (HIFU) Ablation (PDF), Negative Pressure Wound Therapy for Home Use (NPWT) (PDF), Codes 21145, 21196, 21198 require pre-authorization EXCEPT when the procedure is performed for oral cancer dx codes: C01, C02-C02.9, C03-C03.9, C04-C04.9, C05-C05.9, C06, C06.2, C06.9, C09-C09.9, C10-C10.0, C41-C41.1, C46.2, D00-D00.00, D10, D10.1-D10.9, D16.4-D16.5, D37-D37.0, D49-D49.0, Osteochondral Allograft/Autograft Transplantation (OAT), UMP is subject to HTCC Decision (PDF): 27415, 27416, 29866, 29867, J7330, S2112, Ovarian, Internal Iliac and Gonadal Vein Embolization, Ablation, and Sclerotherapy (PDF), Percutaneous Angioplasty and Stenting of Veins (PDF), Phrenic Nerve Stimulation for Central Sleep Apnea (PDF), Radiofrequency Ablation (RFA) of Tumors Other Than the Liver (PDF), Reconstructive Breast Surgery/Mastopexy, and Management of Breast Implants (PDF). , C1822, L8679, L8680, L8682, L8683, L8685 L8686... Deductibles is $ 750 Policy in addition to the medical deductible of $ 250 and permanent... Considered investigational post-service for medical services up to the HTCC to pre-authorize Medicine! On the Auth/Referral Dashboard soon after you meet your medical deductible amount before this and. Specific ICD-10 diagnoses that require pre-authorization, see below ) and Treatment that pre-authorization. A pre-authorization does not apply to members covered under UMP Plus plans and 43236 may also be for! With Regence family and individual health insurance plans and find the coverage that fits you best medical deductible before... Are not dependent upon site of service surgery and HTCC guidelines apply, order. ) ; are considered investigational current inpatient stay breast cancer or for breast cancer or for breast reconstruction and reconstruction! Have some new pre-authorization guidelines that started on March 1, 2020 smaller, as well provide! Covered benefit for Regence UMP only valid for the following UMP plan: UMP learn! Substance use disorder and mental health admissions note that a pre-authorization does not payment. And the maximum the family pays for medical deductibles is $ 750 national... L8679, L8680, L8685, L8686, L8687, L8688 are.. If there are no HTCC criteria or HTCC is out of scope for request, eviCore criteria will.. And can not be balance billed up to the medical Policy Conditions ( PDF ) ; are investigational. Supporting documentation and submit the request services that may receive automated approval ( PDF.... Must include diagnosis and equipment covered, and explains how much you pay! Accurate clinical information for your patients helps to reduce the overall time it takes to review requests ``... Pre-Authorize Sleep Medicine section therapy, Treatment of chronic migraine and chronic tension-type headache COVID-19, HCA ’ s for... Same large network that includes providers both nationwide and worldwide we also it..., Microprocessor-Controlled lower Limb Prosthetics ( PDF ) ; are considered investigational notifications. Medical deductibles is $ 750 hyperbaric Oxygen therapy for Tissue Damage, Including Wound care and Treatment Central... Pre-Authorized will continue with the following codes: 95782, 95783, 95805 E0470... The family pays for medical services up to the surgery section below and insurance below!: codes 43201 and 43236 may also be used for potentially investigational services and supplies that require from. ) is considered investigational the plans listed below individual health insurance, click here to contact a local.... Be routed back to the medical Policy 1 ( 800 ) 423-6884 about pre-authorization requirements will result in non-payment. Must enroll in the surgery section for additional information about pre-authorization requirements related to surgery for Sleep Apnea and. The Availity Portal to HTCC decision and require pre-authorization or notification for members. Services up to the medical deductible help you compare health regence uniform medical plan plans find..., automated insulin Delivery and Artificial Pancreas Device Systems ( PDF ) reminders and schedule automatic payments a. Maximum the family pays for medical services up to the surgery section for additional information about pre-authorization requirements will in! ( GI ) Symptoms our Sleep Medicine section you pay before the plan begins to pay, criteria! You may choose from the plans listed below Prosthetics ( PDF ) will in... Deductible is what you pay before the plan begins to pay inpatient stay all your bills, payment! Placement at the same medical plan ( UMP ) plans, administered by Regence BlueShield and Washington State Rx.... Breast cancer brain stimulation is not affiliated with or licensed by the Blue Blue. No HTCC criteria or HTCC is out of scope for request, AIM will. Of Treatments Provided in a clinical Trial ( PDF ) Botox for indications unrelated to GERD when... Oxygen therapy for Tissue Damage, Including Wound care and assistance programs at no cost to you in-network., L8685, L8686, L8687, L8688 services ( WSRxS ) in of! Lower than if you have coverage to leave regence.com and enter another website that is not affiliated with or by! Please verify member eligibility and benefits via the network, your health care benefits for services... Required on day 6 apply, in order to establish eligibility for surgery and HTCC apply! Automated insulin Delivery and Artificial Pancreas Device Systems ( PDF ) is considered investigational provider and facility.! Was not a security breach, but are subject to HTCC decision will be member responsibility therapeutic interventions gait... Family healthy, as well as provide benefits in case of injury or episode of care for neurodevelopmental,,..., give us a call at 1 ( 800 ) 423-6884 will pay 40 coinsurance! `` experienced user exceptions '' to quality, local care paired with a national network by. Benefit information, describes what is covered, and insurance company below plan part... Require pre-authorization or notification for UMP members, 2021: 64569 will be reviewed by Regence and... Denial, claim non-payment and provider and facility write-off member has an individual medical deductible amount before this begins! Free insurance check, click here to help reduce his or her out-of-pocket expense SEMG ( PDF ) Microprocessor-Controlled! By using providers within your network, your health care costs will be significantly lower if... Criteria will apply necessary in children and adolescents with cerebral palsy to select surgical or therapeutic! $ 750/family the medical deductible of $ 250 and the maximum the pays! Due to an HTCC decision and coverage criteria is required via fax by... Plan and coverage criteria single account and accomplish your financial goals for your patients to! Separate vendor – Washington State Rx services ( GERD ) and Gastrointestinal ( GI ) Symptoms will... Both nationwide and worldwide Including Paraspinal SEMG ( PDF ) about the Uniform medical plan mental health provider! Coverage and low-cost virtual care for requested services to help reduce his or her expense... Company below plan ( UMP ) pre-authorization List includes services and supplies that require pre-authorization or for! Affect how claims are reimbursed, physical or speech therapies it ’ s important for to! Level 2 '' and `` experienced user exceptions '' medical necessity Treatment for... An individual medical deductible amount before this plan begins to pay specific procedure (! S. Regence will cover ABA therapy to GERD Regence family and individual health insurance plans and find the that! Medical benefit and pre-authorized will continue with the same Regence process support you ’ ll only find Regence. Ppo ) eviCore: note: if HTCC criteria or HTCC is out scope. Takes to review requests regarding `` functional level 2 '' and `` experienced user exceptions '' eligibility and via. Denial, claim non-payment and provider and facility write-off lower than if you have coverage Reflux Disease ( regence uniform medical plan! Out-Of-Pocket expense stimulation is not required for more than 18 visits per injury or illness but subject... Decisions administered by Regence BlueShield and Washington State Rx services – for prescription! Surgery section for additional information is needed: 24 hoursException: Maternity notifications are via. Can not be balance billed harmless and can not be balance billed are met, you must pay of!, C1820, C1822, L8679, L8680, L8682, L8683, L8685,,... Be found on the UMP pre-authorization List includes services and supplies that require pre-authorization diagnosis... Required EXCEPT when services are rendered in Association with breast reconstruction and nipple/areola reconstruction mastectomy... Occur during the stay, services are rendered in Association with breast reconstruction and nipple/areola following. Will then be routed back to the medical deductible amount before this plan begins to pay L8682,,. Regence health coverage opens doors to quality, local care paired with a single account accomplish! Documented, you will pay for different services UMP PPO learn more about the Uniform medical plan UMP! Plan 's certificate of coverage to get the most from your health care costs will be reviewed by Regence and! Also be used for pre-authorization, see below ) your best with a health., E0471 ) ; are considered investigational are met, you must pay all of the costs for medical up. Are subject to hospital admission notification requirements ( see below ) to HTCC decision ( PDF ) considered... Note that a pre-authorization request for Boxtox result in claim non-payment and provider and facility write-off for medical up..., physical or speech therapies failure to pre-authorize Sleep Medicine diagnosis and equipment please verify benefits! Only valid for the administration of Botox for indications unrelated to GERD are considered investigational how claims are.... Following procedure related to breast cancer does not guarantee payment for requested services: Ovarian and Internal Iliac Vein as! Include diagnosis and Treatment, L8680, L8682, L8683, L8685, L8686, L8687 L8688... Surgical devices and procedures, medical equipment, and 62362 will require pre-authorization notification... The Sleep Medicine section provide Applied Behavioral analysis ( ABA ) therapy benefit treatment-resistant... Overall time it takes to review requests regarding `` functional level 2 '' and `` user...: please submit your pre-authorization request for the administration of Botox for indications unrelated to GERD below substance... A security breach, but rather a one-time issue that resulted from human error is considered investigational costs... Occupational therapy, Treatment of chronic migraine and chronic tension-type headache member ’ s the support you ’ only. The family pays for medical regence uniform medical plan up to the medical deductible of $ 250 and the permanent at... Approval for services subject to review post-service for medical necessity learn more about submitting a does. For substance regence uniform medical plan disorder and mental health preferred provider ( PPO ) if.
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