Uniform plan claim 2026

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The document is a Medical Claim Form for submitting reimbursement requests for services received from non-network providers under the Uniform Medical Plan (UMP). It outlines the necessary steps to complete the form, including attaching itemized bills and providing personal and insurance information. The form must be submitted within one year of service, and it includes sections for additional insurance coverage and certification of information accuracy.

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Click ‘Get Form’ to open the uniform plan claim in the editor.
Begin by filling in the patient’s information, including their last name, first name, date of birth, and relationship to the subscriber. Ensure accuracy as this information is crucial for processing your claim.
Next, provide details about the subscriber, including their last name, first name, and group information. This helps identify the insurance coverage associated with the claim.
In the 'Other Insurance Information' section, indicate if you or any family members have additional coverage. If yes, complete the relevant fields to ensure all insurance details are captured.
Attach itemized bills that include necessary details such as diagnosis and procedure codes. This documentation is essential for reimbursement.
Finally, sign and date the form at the bottom before submitting it to Regence BlueShield via mail or fax. Retain copies for your records.

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Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (208 Votes)
2020	4.4 Satisfied (60 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is UMP the same as Regence?

UMP offers five different health plans administered by Regence BlueShield and ArrayRx (formerly known as Washington State Rx Services).

What is UMP coverage?

Your UMP health plan is a valuable benefit that includes medical and prescription drug coverage to help you stay healthy and pay for the cost of an illness or injury. When you see a network provider for covered preventive care servicesincluding routine annual physical exams and certain immunizationsyou pay $0.

What is UMP medical?

Uniform Medical Plan (UMP) is a self-insured health plan offered through the Washington State Health Care Authoritys (HCA) Public Employees Benefits Board (PEBB) Program and the School Employees Benefits Board (SEBB) Program.

What is UMP healthcare?

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 States Public Employees Benefits Board (PEBB) Program. UMP is administered by Regence BlueShield and ArrayRx.

What is UMP in medical terms?

Uridine monophosphate (UMP), also known as 5-uridylic acid (conjugate base uridylate), is a nucleotide that is used as a monomer in RNA. It is an ester of phosphoric acid with the nucleoside uridine.

ump medical claim

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What does UMP stand for in healthcare?

Uniform Medical Plan (UMP) | Washington State Health Care Authority.

What is a uniform plan?

Uniform plan means a workers compensation statistical plan, classification plan or experience rating plan designated by the director pursuant to section 20-371, subsection J.