Uniform Medical Plan (UMP) is a preferred provider health plan managed by the Washington State Health Care Authority (HCA) through the Public Employees Benefits Board (PEBB). The plan serves state and public employees, retirees and their dependents.
Category III CPT codes for Applied Behavior Analysis treatment
The American Medical Association released a new series of Category III CPT codes, CPT 0359T-0374T, applicable to ABA treatment effective July 1, 2014. We are reviewing how best to implement and cross-walk these new codes to currently available codes. Until that review is complete and these codes are fully implemented, they are non‑reimbursable.
For UMP members, please continue to use the codes found on the UMP Pre-authorization list (Scroll down to the Chemical Dependency and Mental Health section).
Diabetes prevention and control program
(January 1, 2014)
A new wellness program is available to UMP members. NOT ME® is a personal health campaign available to UMP members by the Diabetes Prevention and Control AllianceSM (DPCA).
The program is available at no cost to UMP members who:
- Are age 18 or over
- Are enrolled in UMP and
- Don’t have Medicare or another insurance carrier as their primary insurance.
Diabetes prevention program:
NOT ME is a type 2 diabetes prevention program that works through workplace testing events and local health coaches to help members determine if they have pre-diabetes and to learn how to prevent diabetes through small habit changes.
Diabetes control program:
For members with diabetes, NOT ME representatives will encourage members to enroll in a series of quarterly consultations with a Safeway pharmacist trained to help them reduce the risk of complications by tracking and controlling blood sugar, cholesterol levels, blood pressure and weight.
Bariatric surgery changes
- Effective January 1, 2014, UMP members will follow the Regence medical policy for coverage of bariatric surgery.
- UMP members must complete the assessment form and submit it to Regence to engage with a case manager who will advise of the medical policy criteria and ensure the requirements are met before surgery is authorized.
- UMP continues to have its own Centers of Excellence to which a case manager will refer the member once surgery is authorized.
- The nutritional counseling program with Accomplish, including the $1,450 paid to Accomplish, is no longer in effect as of November 1, 2013.
Applied Behavior Analysis Therapy benefit for UMP members
UMP members diagnosed with autism spectrum disorder are eligible for coverage of ABA therapy. View the coverage requirements (Scroll down to the Chemical Dependency and Mental Health section). The coverage requirements include the details on how to obtain an authorization (initial and ongoing), covered provider information, etc. Please reference the coverage requirements often for applicable updates to required information.
UMP Pre-authorization List
UMP has unique pre-authorization requirements for professional services, concurrent review and mental health.
UMP Clinical Edits by Code List
The UMP Clinical Edits by Code list applies to UMP members only.
Washington State Health Technology (HTA) Assessments
Under state law, the Uniform Medical Plans (UMP Classic and CDHP) must follow coverage decisions made by the Health Technology Clinical Committee (HTCC). If the Committee has determined that a service or treatment is not covered, then medical necessity is not an issue: it simply isn't covered. If the Committee has determined that a service or treatment may be covered, then it will be covered only in cases where it meets the Committee's specific coverage criteria. Please note that these decisions may be made and take effect at any time during the plan year. View final decisions and ongoing reviews.
HTA decisions supersede Regence Medical Policy. There are times where an HTA decision mirrors Regence Medical Policy and, where they are the same, Regence Medical Policy may be followed. Providing that there are no conflicts with the HTA decisions, UMP follows Regence policy and practice for most services including cosmetic, investigational and unlisted procedures.
Procedures that are subject to HTA decision criteria can be found on the UMP Pre-authorization List. Procedures denied due to an HTA decision will be member responsibility.
Claims submission and billing information
Submit claims for your UMP patients to the local Blue Cross Blue Shield Plan. See the map below to determine the service area in Washington State that applies.
- Regence service area (gray shading in map below): submit UMP claims to Regence.
- Premera service area (white areas of map below): submit UMP claims to Premera BlueCross.
- In Clark County, Washington (gray line shading in map below) submit UMP claims to Regence BlueCross BlueShield of Oregon.
- Outside of Washington State, submit UMP claims to the local Blue Cross Blue Shield Plan.
View additional claims information, including electronic and paper claims submission details and addresses on pages 8 through 11 in the UMP Billing and Administrative Manual for hospitals (PDF).
Important UMP billing information
When submitting UMP claims, please include the three letter alpha prefix and the member number displayed in the ID NO field on the member card. The member number begins with a “W” followed by nine numbers.
If you use the Provider Center to verify eligibility for UMP members, enter only the nine digit member number. Do not include the alpha prefix or the “W” preceding the numbers.
UMP members do not have dental insurance through Regence. Please check the member's dental coverage and submit the claim to the appropriate dental plan.
UMP uses the Regence Preferred Provider Organization (PPO) network, giving UMP members access to Regence providers and the broader Blue Cross and/or Blue Shield networks outside of the Regence service area in Washington and throughout the United States.
Providers and members have access to a designated Regence UMP customer service team Monday through Friday from 7 a.m. to 5 p.m. PST:
- Providers may call 1 (888) 849-3682
- Members may call 1 (888) 849-3681
For information about prescription drug coverage, including specialty drugs, contact Washington State Rx Services at 1-888-361-1611 or visit the UMP web site at www.ump.hca.wa.gov
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