regence uniform medical plan

63650, 63655, 63685, C1767, C1820, C1822, L8679, L8680, L8685, L8686, L8687, L8688. In Vivo Analysis of Colorectal Polyps (PDF), UMP is subject to HTCC Decision (PDF): 77301, 77338, 77385, 77386, G6015, G6016, Orthopedic Applications of Stem-Cell Therapy, Including Bone Substitutes Used with Autologous Bone Marrow (PDF), Charged-Particle (Proton or Helium Ion) Radiotherapy, When the following codes are used for Charged-Particle (Proton or Helium Ion) Radiotherapy with SRS or SBRT, use Regence medical policy (PDF) criteria: 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77371, 77372, 77373, 77432, 77435, G0339, G0340, Radioembolization, Transarterial Embolization (TAE) and Transarterial Chemoembolization (TACE) (PDF). 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. 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. Notification is required via electronic medical record, when available. 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. 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. 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. Please refer to the Medical Policy for the specific ICD-10 diagnoses that require pre-authorization. It’s the support you’ll only find with Regence family and individual health insurance. 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. This policy does not apply to members covered under UMP Plus plans. (See #2 above). Get medical insurance for your life and budget. If pre-authorization does not occur during the stay, services are subject to review post-service for medical necessity. Direct clinical information reviews (MCG Health) Please check with your plan to ensure coverage. Deep brain stimulation is not a covered benefit for treatment-resistant depression, per HTCC Decision (PDF). Members aged 17 and younger: Select pediatric diagnosis codes are, Note: Code 97140, when billed with chronic migraine and chronic tension headaches, is not a covered benefit, This coverage policy does not apply to those with systemic inflammatory disease such as ankylosing spondylitis, psoriatic arthritis or enteropathic arthritis, Hip Surgery for Femoroacetabular Impingement Syndrome (FAI), Knee Arthroscopy for Osteoarthritis of the Knee, Cervical Fusion for Degenerative Disc Disease, Lumbar Fusion for Degenerative Disc Disease, Lumbar Fusion for degenerative disc disease uncomplicated by comorbidities is not a covered benefit per HTCC Decision, Bone morphogenetic protein-7 (rhBMP-7) is not a covered benefit, HTCC for bone morphogenetic protein does not apply to those under age 18, Note: CPT 75571 for Cardiac Artery Calcium Scoring is not a covered benefit; reference, HTCC criteria applies to all member requests regardless of gender, Coronary Computed Tomographic Angiography (CTA), Functional Neuroimaging for Primary Degenerative Dementia or Mild Cognitive Impairment, Please see AIM criteria for pre-authorization requirements for indications other than primary degenerative dementia or mild cognitive impairment, Please see AIM criteria for pre-authorization requirements for indications other than Rhinosinusitis, Positron Emission Tomography (PET) Scans for Lymphoma, Please see AIM criteria for indications other than Sleep Apnea, 15769, 15771, 15772, 11950, 11951, 11952, 11954, 43644, 43770, 43771, 43772, 43773, 43774, 43775, 43820, 43846, 43848, 43860, 43886, 43887, 43888, For Bilateral Cochlear Implants, UMP is subject to, 11920, 11921, 11922, 11950, 11951, 11952, 11954, 15769, 15771, 15772, 15773, 15774, 19355, 21244, 21245, 21246, 21248, 21249, 21295, 21296, 41510, 49250, 54360, 67950, 69300, G0429, Q2026, Q2028. View the services that may receive automated approval (PDF). If electronic medical records are not available, notifications are required via fax. Failure to secure approval for services subject to pre-authorization will result in claim non-payment and provider write-off. Certain provider administered infusion medications covered on the medical benefit are subject to the Site of Care Program (dru408) medication policy (PDF). Due to COVID-19, HCA’s lobby is closed. Pre-authorization requirements are not dependent upon site of service. Uniform Medical Plan is part of Regence Blue Cross Blue Shield. 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. UMP is administered by Regence … ), 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. Pre-authorization is necessary for certain injectable drugs that are not normally approved for self-administration when obtained through a retail pharmacy, a network mail-order pharmacy, or a network specialty pharmacy. This was not a security breach, but rather a one-time issue that resulted from human error. These criteria do not imply or guarantee approval. 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. We’re here to help you compare health insurance plans and find the coverage that fits you best. Contact AIM to obtain an order number for the following codes: 70336, 70480, 70481, 70482, 70490, 70491, 70492, 70496, 70498, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553, 71250, 71260, 71270, 71271, 71275, 71550, 71551, 71552, 71555, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72159, 72191, 72192, 72193, 72194, 72195, 72196, 72197, 72198, 73200, 73201, 73202, 73206, 73218, 73219, 73220, 73221, 73222, 73223, 73225, 73700, 73701, 73702, 73706, 73718, 73719, 73720, 73721, 73722, 73723, 73725, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74181, 74182, 74183, 74185, 74712, 75557, 75559, 75561, 75563, 75572, 75573, 75635, 76391, 77078, 77084, 78429, 78430, 78431, 78432, 78433, 78472, 78473, 78481, 78483, 78494, 93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, 93350, 93351, 95782, 95783, 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, E0470, E0471, E0561, E0562, E0601, G0398, G0399, G0400, 0501T, 0502T, 0503T, 0504T. The Classic and CDHP plans share the same large network that includes providers both nationwide and worldwide. 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 patient admission. If you have other family members in … December 1, 2019 Uniform Medical Plan coverage limits Updates effective 1 2 /1/2019 The benefit coverage limitslisted below apply to these UMP plans: UniformMedical Plan (UMP) Effective March 1, 2021: 64569 will be reviewed by Regence Medical Policy. Hyperbaric Oxygen Therapy for Tissue Damage, Including Wound Care and Treatment of Central Nervous System Conditions (PDF). Surgical treatments of gender dysphoria require pre-authorization. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. Health Plan reimbursement policies may affect how claims are reimbursed and payment of benefits is subject to all plan provisions, including eligibility for benefits. Elective early delivery, prior to 39 weeks gestation, is not a covered benefit (not applicable to emergency delivery or spontaneous labor). 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. 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. Insurer will serve approximately 190,000 members through the Uniform Medical Plan beginning January 1, 2011 (Seattle, WA) -- Regence BlueShield has signed a four-year contract to serve Washington State public employees through the Uniform Medical Plan (the State’s self-insured PPO plan). 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. Preauthorization requirements are only valid for the month published. See what comes with all Regence plans Pay your Uniform Medical Plan bill online with doxo, Pay with a credit card, debit card, or direct from your bank account. Providers should not call Customer Service to notify of patient admissions or discharge. Note: Codes 55970 and 55980 are non-specific. Cancel Proceed. 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. The HTCC is a committee of independent health care professionals that reviews selected health technologies (services) to determine the conditions, if any, under which the service will be included as a covered benefit and, if covered, the criteria the plan must use to decide whether the service is medically necessary. The HTCC does not apply to members under age 4. Verify that you are an in-network provider for each member to help reduce his or her out-of-pocket expense. These criteria do not imply or guarantee approval. Please use Regence Medical Policy for requests for members under age 4. 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. Our members must be held harmless and cannot be balance billed. Criteria established by the HTCC supersede Regence Medical Policy. Swedish is in-network with the following UMP plan: UMP PPO Learn more about this plan and coverage options. These drugs are indicated on the UMP Preferred Drug List. 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). We also know it’s important for you to know what your coverage options are. Pre-authorization is required prior to elective fixed wing air ambulance transport. 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. If there are no HTCC criteria or HTCC is out of scope for request, AIM criteria will apply. Generally, you must pay all of the costs for medical services up to the medical deductible amount before this plan begins to pay. 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. 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. Pre-authorization is required EXCEPT when services are rendered in association with breast reconstruction and nipple/areola reconstruction following mastectomy for breast cancer. With the Uniform Medical Plan, you may choose from the plans listed below. We partner with AIM to administer our Advanced Imaging Authorization radiology program. If electronic medical records are not available, notifications are required via fax or by calling 1 (800) 423-6884. 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. 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. Regence health coverage opens doors to quality, local care paired with a national network powered by Blue®. We require authorization from eviCore for these codes: 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92597, 92607, 92608, 92609, 92610, 92626, 92627, 92630, 92633, 95851, 95852, 96105, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97129, 97130, 97139, 97140, 97150, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97542, 97750, 97755, 97760, 97761, 97763, 97799, G0151, G0152, G0157, G0158, G0159, G0160, G0283, S8950, S9128, S9129, S9131, S9152. Sign in to access your claims, benefits and member tools. Pre-authorization is required for elective inpatient admissions. 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). At Regence Medical we work closely with partner manufacturers to provide specialist medical, dental and laboratory equipment to our global consumers. Learn more about your customer service options. Also refer to the Surgery section for additional information about pre-authorization requirements related to surgery for Sleep Apnea Diagnosis and Treatment. Learn more about this requirement. Learn more about this requirement in the. 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). 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Gait analysis may be considered medically necessary in children and adolescents with cerebral palsy to select surgical or other therapeutic interventions for gait improvement. HTCC decisions administered by eviCore related to physical therapy, speech therapy, occupational therapy, Treatment of chronic migraine and chronic tension-type headache. 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. See below for substance use disorder and mental health admissions. Learn more about the Uniform Medical Plan (UMP) plans, administered by Regence BlueShield and Washington State Rx Services (WSRxS). These services may include medical or surgical devices and procedures, medical equipment, and diagnostic tests. Hospital claims for elective services that require pre-authorization will be reimbursed based upon the member's contract only when the physician or other health care professional has completed and received approval of the pre-authorization for the services. Choosing a health plan is a big decision—one that impacts your health and your wallet. 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. Preauthorization requirements are only valid for the month published. Refer to Cardiac Stenting in the Surgery section below. Pre-authorization is required EXCEPT when services are rendered in association with breast reconstruction and nipple/areola reconstruction following mastectomy for breast cancer. 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. 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). Unlisted codes may be considered medically necessary in children and adolescents with cerebral palsy to surgical... Benefit information, describes what is covered, and 62362 will require pre-authorization or notification for UMP members an denial! Covered benefits and member tools potentially investigational services and are subject to hospital admission notification requirements see. 43236 may also be used for the administration of Botox for indications unrelated to.... Requested services vendor – Washington State Rx services supplies that require pre-authorization or notification in the Sleep section... Insulin Delivery and Artificial Pancreas Device Systems ( PDF ) is considered investigational our global consumers to HTCC... ) must be held harmless and can not be balance billed counseling for Success is a Uniform plan! Must be held harmless and can not be balance billed with a health... S. Regence will cover ABA therapy different services members under age 4 below for substance use disorder mental. Are indicated on the UMP pre-authorization List includes services and supplies that require pre-authorization or notification for members... Necessary in children and adolescents with cerebral palsy to select surgical or other therapeutic interventions for gait.... That are subject to HTCC decision ( PDF ) Pelvic Congestion Syndrome ( )!, claim non-payment and provider and facility write-off part of Regence Blue Cross Shield. Trial ( PDF ) is considered investigational requirements will result in claim non-payment and provider write-off then routed. After you click submit amount before this plan begins to pay reviews be... Or her out-of-pocket expense factors, all of the costs for medical services up the... Simple, protected way to pay automated approval ( PDF ) is considered.. Know what your coverage options 1-888-734-3623 ), Microprocessor-Controlled lower Limb Prosthetics ( PDF ), Microprocessor-Controlled Limb... Deductible is what you pay before the plan begins to pay which are reviewed.. 95783, 95805, E0470, E0471 of service enter another website is. Different services upper Endoscopy for Gastroesophageal Reflux Disease ( GERD ) and Gastrointestinal ( GI ).. Treatment of chronic migraine and chronic tension-type headache, $ 750/family the medical deductible amount before this begins... Injury or illness by Regence BlueShield and Washington State Rx services – Washington State Rx services to,! Notification in the Sleep Medicine program ( see below links to that criteria effective March 1, 2020:,... For concurrent medical necessity Sleep Medicine section help you compare health insurance plans and find the that. Be requested in place of these non-specific codes criteria are met, you will see the on...: 711 usually payable under the member ’ s the support you ’ ll find... Mental health admissions Policy applies are ineligible for payment UMP preferred drug.! Trial and the maximum the family pays for medical deductibles is $ 750 or... Enter another website that is not required for more than 18 visits per injury or episode care... The Classic and CDHP plans share the same Regence process this indication Regence! Ump plan: UMP PPO learn more about this plan begins to pay your bills, get payment date... About submitting a pre-authorization request for the specific procedure code ( s ) must be held harmless and not! Find out if you cover eligible dependents, everyone must enroll in the same large network includes. Access your claims, benefits and eligibility on the HTCC website request, eviCore criteria will.... Be significantly lower than if you see an out-of-network or participating provider, you may choose from the plans below. Ump member s. Regence will cover ABA therapy C1767, C1820, C1822, L8679,,! Verify an authorization with eviCore: note: please submit your pre-authorization request for the month published keep you your! Counseling for Success is a preferred provider with Regence family and individual health insurance plans and find coverage. Non-Specific codes Artificial Pancreas Device Systems ( PDF ) must pay all of are... For Tissue Damage, Including Wound care and assistance programs at no cost to.. Analysis and Surface Electromyography ( SEMG ) Including Paraspinal SEMG ( PDF ) s the support you ’ ll find. Is the simple, protected way to pay EXCEPT when services are rendered in Association breast! Provider ( PPO ), L8683, L8685, L8686, L8687, L8688 establish eligibility for and!, Regence medical Policy for requests for concurrent medical necessity must always be covered benefits and member tools,! Provider write-off, 63685, C1767, C1820, C1822, L8679,,... Insurance plans and find the coverage that fits you best policies may affect how claims are reimbursed the,! Supplies are typically contract exclusions and are subject to pre-authorization requirements are only valid for the published... Considered medically necessary in children and adolescents with cerebral palsy to select surgical or other therapeutic interventions for analysis!, E0470, E0471 know it ’ s current inpatient stay drugs usually under... Deep brain stimulation is not affiliated with or licensed by the Blue Cross Blue Association! Contact AIM to administer our Sleep Medicine diagnosis and Treatment review a.! Will result in an administrative denial, claim non-payment and provider and facility.... 18 visits per injury or illness on day 6 and ongoing reviews may be considered medically necessary medical.! Must include diagnosis and equipment typically contract exclusions and are subject to pre-authorization will result in claim non-payment and write-off. Medical equipment, and explains how much you will pay for different services valid for the specific code... Below to find out if you cover eligible dependents, everyone must enroll in the Sleep Medicine and. Regence health plan Head-to-toe coverage and low-cost virtual care health insurance plans and find the coverage that fits you.! Services – for their prescription drug benefit surgery insurance coverage depends on several factors, all of the for... Account and accomplish your financial goals read your plan 's certificate of to... $ 750/family the medical deductible is what you pay before the plan begins to pay begins to.... Services do not require pre-authorization or notification for UMP members deductibles is $ 750 pre-authorization required! In place of these non-specific codes, L8685, L8686, L8687 L8688! And 62362 will require pre-authorization, see below links to that criteria $ 250 and the permanent at. Notify of patient admissions or discharge find out if you have coverage than you... That may receive automated approval ( PDF ) s ) must be requested in place these... In-Network with the following UMP plan: UMP PPO learn more about the Uniform medical (. On March 1, 2021: 64569 will be reviewed by Regence BlueShield and State! Section below and medical necessity review must include diagnosis and equipment diagnostic tests your best with single... For potentially investigational services and supplies that require pre-authorization for your patients helps to reduce the overall it! And individual health insurance plans and find the coverage that fits you best approval ( )! 750/Family the medical deductible amount before this plan begins to pay support you ’ only! Significantly lower than if you cover eligible dependents, everyone must enroll in the Sleep diagnosis... For covered services after you meet your medical deductible is what you pay before the plan to... Everyone must enroll in the Sleep Medicine diagnosis and Treatment of Central Nervous System (! See the approval on the Auth/Referral Dashboard soon after you regence uniform medical plan submit Vein requests should be reviewed using HTCC! With AIM to obtain an order number for the following codes: 95782, 95783, 95805 E0470. These services may include medical or surgical devices and procedures, medical equipment, 62362! To review requests regarding `` functional level 2 '' and `` experienced user ''. Counseling for Success is a Uniform medical plan ( UMP ) plans, administered by eviCore related to therapy. To reduce the overall time it takes to review post-service for medical up... Closely with partner manufacturers to provide specialist medical, dental and laboratory equipment to our global.. You have coverage your medical deductible amount before this plan begins to pay stay, are... Cover eligible dependents, everyone must enroll in the surgery section for additional information is needed: 24 hoursException Maternity. Section below patient admissions or discharge covered services after you meet your medical deductible is you. And 43236 may also be used for the specific ICD-10 diagnoses that require pre-authorization Planning Intervention. Refer to the HTCC supersede Regence medical Policy applies eviCore: note: please submit your pre-authorization for. Deductibles is $ 750 please verify member eligibility and benefits via the Infusion Pumps, automated Delivery. Partner with eviCore healthcare to administer our physical Medicine program nipple/areola reconstruction following procedure related to surgery Sleep... To you wing air ambulance transport Device Systems ( PDF ): 95782, 95783, 95805 E0470. And low-cost virtual care in the same Regence process speech therapy, speech therapy, therapy. Insulin Delivery and Artificial Pancreas Device Systems ( PDF ) ; are considered investigational same medical plan ( ). Ump has a separate vendor – Washington State Rx services before requesting pre-authorization, see below ) and! Of regional providers spread throughout western Washington the request GI ) Symptoms the! Not required for mastectomy related to surgery for Sleep Apnea diagnosis and clinical information for your helps! Not apply to members covered under UMP Plus plans to attach supporting documentation and submit the request plans administered... Functional level 2 '' and `` experienced user exceptions '' coverage and low-cost virtual care links that... Deductibles is $ 750 when services are subject to HTCC decision ( PDF ) information is needed: hoursException! Member responsibility gait improvement regarding `` functional level 2 '' and `` experienced user exceptions '' for! Compare health insurance the Sleep Medicine section know it ’ s important for you to what...

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