Joint administration

Joint administration employer groups

Joint administration describes a partnership between Regence and a third-party administrator (TPA).

Through these arrangements, Regence:

  • Builds and maintains our medical provider network
  • Prices medical claims based on our reimbursement rates
  • Develops and maintains our pre-authorization list and medical and reimbursement policies
  • Supports providers through our Provider Contact Center and Provider Relations teams
  • Sends payment to providers

The TPA:

  • Contracts with employer groups
  • Calculates the members' benefits
  • Receives pre-authorization requests from providers
  • Supports members through the TPA's medical management program
  • Supports members through the TPA's customer service team
  • Sends payment to members, if applicable

Regence has partnered with AmeriBen to serve the following employer groups:

  • Alpha Media
  • Alsco Inc.
  • Avalon Health Care Inc.
  • CHG Healthcare Services
  • CTI Foods (effective January 1, 2020)
  • IEC Group
  • J-U-B Engineers, Inc.
  • Sportsman's Warehouse Holdings Inc.

Regence and Zenith American Solutions have partnered to serve the following health trusts:

  • U.A. Local Union 290 Plumber, Steamfitter & Shipfitter Health Trust (U.A. Local Union 290)
  • UFCW Local 555-Employers Health Trust

Ameriben employer groups

The following national self-funded employer groups have access to our provider networks:

Regence BlueShield of Idaho service area:

  • CTI Foods (group #70000011) – BlueCard PPO Network (effective January 1, 2020)
  • IEC Group (group #70000000) - All members (with the exception of Utah) will have access to the Preferred network. Utah members will have access to the BlueCard Traditional Network.
  • J-U-B Engineers, Inc. (group #70000009) – Utah and Wyoming members will have access to the local participating network, and members outside of Utah and Wyoming will have access to the BlueCard PPO Network.

Regence BlueCross BlueShield of Oregon service area:

  • Alpha Media (group #70000010) – All members (with the exception of Utah and Wyoming) will have access to the Preferred network. Utah and Wyoming members will have access to the BlueCard Traditional Network.

Regence BlueCross BlueShield of Utah service area:

  • Alsco Inc. (group #70000002) - Utah and Wyoming members will have access to the local participating providers, and members outside of Utah and Wyoming will have access to the BlueCard PPO Network.
  • Avalon Health Care Inc. (group #70000007) - Utah and Wyoming members will have access to the local participating providers, and members outside of Utah and Wyoming will have access to the BlueCard PPO Network.
  • CHG Healthcare Services (group #70000004) - Preferred ValueCare Network
  • Sportsman's Warehouse Holdings Inc. (group #70000008) - Utah and Wyoming members will have access to the local participating providers, and members outside of Utah and Wyoming will have access to the BlueCard PPO Network.

Members traveling or residing outside of the Regence service area have access to the BlueCard Traditional or BlueCard PPO networks.

Reimbursement is based on your Regence agreement, and provider servicing is performed by Regence.

AmeriBen, the third-party administrator, provides claims administration, medical management and Customer Service for these members.

Identifying members

Easily identify members on these groups by their prefix and member card.

Included below are the prefixes and BlueCard suitcase logos that appear on the member cards:

  • Alpha Media: A3M (PPO in the suitcase logo) and A5M (blank suitcase logo)
  • Alsco Inc.: QAL (PPO in the suitcase logo) and YAL (blank suitcase logo)
  • Avalon Health Care Inc.: QIV (PPO in the suitcase logo) and TIV (blank suitcase logo)
  • CHG Healthcare Services: ZHG (PPO in the suitcase logo)
  • CTI Foods: C3T (PPO in the suitcase logo)
  • IEC Group: IEA (PPO in the suitcase logo) and XNV (blank suitcase logo)
  • J-U-B Engineers: J2B (PPO in the suitcase logo) and J3B (blank suitcase logo)
  • Sportsman's Warehouse Holdings Inc.: OJW (PPO in the suitcase logo) and ZJW (blank suitcase logo)

View the sample member cards below (front/back). Note: The sample cards below include a placeholder prefix of SMPL (sample).

Alsco sample member card

Alsco member card frontAlsco member card back

Eligibility, benefits and claim status

Access member eligibility and benefits and claim information via the Availity Provider Portal, the same as you do today for your other Regence patients. Eligibility is transferred from AmeriBen to Regence on a weekly basis for these members.

Pharmacy benefits

The following companies administer the pharmacy benefits for both retail and mail order prescriptions:

  • Alpha Media: Express Scripts
  • Alsco Inc.: VRx Pharmacy
  • Avalon Health Care Inc.: EnvisionRx
  • CHG Healthcare Services: Navitus Health Solutions (See information in Pre-authorization section below regarding the pre-authorization requirement for certain specialty medications.)
  • CTI Foods: Express Scripts
  • IEC Group: Navitus Health Solutions (See information in Pre-authorization section below regarding the pre-authorization requirement for certain specialty medications.)
  • J-U-B Engineers: Navitus Health Solutions
  • Sportsman's Warehouse Holdings Inc.: Magellen Rx Management

Pre-authorization

Our Commercial Pre-authorization List applies to these members. Providers need to obtain pre-authorization from AmeriBen Medical Management for these members as indicated on the Commercial Pre-authorization List.

Notes:

  • Dialysis treatment: A pre-notification requirement is included on our Commercial Pre-authorization List for dialysis treatments for Alsco Inc., Avalon Health Care Inc., CHG Healthcare Services, IEC Group and Sportsman's Warehouse Holdings Inc. members. Providers need to submit pre-notifications for dialysis treatment to AmeriBen Medical Management for these members.
  • Specialty medications: Pre-authorization for certain specialty medications is required for CHG Healthcare Services (group #70000004) and IEC Group (group #70000000) members. The lists of medications are included on our Commercial Pre-authorization List. Submit pre-authorizations for these specialty medications to VIVIO Health Help Desk at 1 (925) 365-6600. This phone number should only be used for pre-authorizing specialty medications for these members. Note: Effective January 1, 2020, pre-authorization for specialty medications will be required for Alsco Inc. (group #70000002) members. The list of medications is included on our Commercial Pre-authorization List.

Medical management

AmeriBen Medical Management supports members on these groups. These members are excluded from the Regence BabyWise, Physical Medicine, Sleep Medicine and radiology programs offered by Regence.

Contact AmeriBen Medical Management at the following phone numbers for pre-authorization requests and medical management support for these members:

  • Alpha Media: 1 (877) 955-1570
  • Alsco Inc.: 1 (855) 778-9047
  • Avalon Health Care Inc.: 1 (866) 504-6812
  • CHG Healthcare Services: 1 (855) 258-6451
  • CTI Foods: 1 (833) 951-1370
  • IEC Group: 1 (866) 947-9522
  • J-U-B Engineers: 1 (866) 955-1490
  • Sportsman's Warehouse Holdings Inc.: 1 (855) 240-3696

Claims and payment

Submit claims electronically for these members the same way you submit claims for your other Regence patients.

You will receive payment the same way you do for your other Regence patients.

Customer service

Our Regence Contact Center and Provider Relations team supports providers for these members.

Members should contact AmeriBen at the following phone numbers:

  • Alpha Media: 1 (877) 955-1576
  • Alsco Inc.: 1 (866) 504-6814
  • Avalon Health Care Inc.: 1 (866) 504-6811
  • CHG Healthcare Services: 1 (888) 268-5963
  • CTI Foods: 1 (833) 951-1367
  • IEC Group: 1 (866) 947-9522
  • J-U-B Engineers: 1 (866) 215-0978
  • Sportsman's Warehouse Holdings Inc.: 1 (866) 955-1487

Appeals

Provider appeals for these members follow the same process as provider appeals for other Regence members.

Appeals requested on behalf of these members need to be submitted to AmeriBen within 180 days of receipt of the written notification of an adverse benefit determination. Please submit appeals on behalf of these members to:

AmeriBen
Attention: Appeals Coordinator
P.O. Box 7186
Boise, ID 83707

For member appeals, AmeriBen will send a copy of the written determination to the member and provider. The Appeals for members section of our Administrative Manual includes this information.

Zenith American Solutions health trust

The following health trusts have access to our Regence BlueCross BlueShield of Oregon (Regence BCBSO) Preferred Network:

  • U.A. Local Union 290 Plumber, Steamfitter & Shipfitter Health Trust (U.A. Local Union 290) (group #70000003)
  • UFCW Local 555-Employers Health Trust (group #70000005)

Members traveling or residing outside of the Regence service area have access to the BlueCard PPO and Blue Cross Blue Shield Global Core networks.

Reimbursement for these members is based on your Regence agreement and provider servicing for participating providers remains with Regence.

Zenith American Solutions, the third-party administrator (TPA), provides claims administration, medical management and Customer Service for these members.

Identifying members

Easily identify members of these groups by their member cards. Included below are the prefixes and BlueCard suitcase logos that appear on the member cards:

  • U.A. Local 290: OUA (PPO in the suitcase logo)
  • UFCW Local 555-Employers Health Trust: OUF (PPO in the suitcase logo)

U.A. Local 290 sample member card

UA Local union 290 member card frontUA Local union 290 member card back

Eligibility, benefits and claim status

You can access member eligibility and benefits and claim information via the Availity Provider Portal, the same as you do for your other Regence patients.

Note: Massage therapy for UFCW Local 555-Employers Health Trust (group #70000005) members is covered only when services are performed by a Practitioner (as defined by the group), which includes chiropractors, osteopaths and physical therapists. Services provided by a licensed massage therapist or massage therapist are not covered.

Pharmacy benefits

The following companies administer the pharmacy benefits for both retail and mail order prescriptions:

  • U.A. Local Union 290: Express Scripts
  • UFCW Local 555-Employers Health Trust: EnvisionRx

Pre-authorization

Our Commercial Pre-authorization List applies to U.A. Local Union 290 and UFCW Local 555-Employers Health Trust members. Providers need to obtain pre-authorization from Innovative Care Management for these members online or by phone at (503) 654-9447 or 1 (800) 862-3338.

Claims submission and payment

Submit electronic claims for these patients with your other Regence patients.

Medical management

U.A. Local Union 290 and UFCW Local 555-Employers Health Trust members are excluded from Regence BabyWise, Physical Medicine, Radiology Quality Initiative and Sleep Medicine programs offered by Regence.

Customer service

Our Provider Contact Center and Provider Relations team supports providers for these members.

Non-participating providers should contact Zenith American Solutions at:

  • U.A. Local Union: 1 (866) 796-2305
  • UFCW Local 555-Employers Health Trust: 1 (866) 796-7623

Members should contact Zenith American Solutions at:

  • U.A. Local Union: (503) 486-2104 or 1 (866) 796-2305
  • UFCW Local 555-Employers Health Trust: 1 (866) 796-7623

Appeals

Provider appeals for these members follow the same process as provider appeals for other Regence members.

Appeals requested on behalf of these members need to be submitted to Zenith American Solutions within 180 days of receipt of the written notification of an adverse benefit determination. Please submit appeals on behalf of these members to:

Level 1 member appeals for U.A. Local 290 and all appeals for UFCW Local 555-Employers Health Trust:

Zenith American Solutions
Benefits and Claims department
Attention: Appeals Coordinator
12205 SW Tualatin Road, Suite 200
Tualatin, OR 97062

Level 2 member appeals for U.A. Local 290:

The Board of Trustees
U.A. Union Local No. 290
Plumber, Steamfitter and Shipfitter Industry
Attention: Appeals Coordinator
12205 SW Tualatin Road, Suite 200
Tualatin, OR 97062

For questions about member appeals, contact Zenith at the following phone numbers:

  • U.A. Local Union 290: 1 (866) 796-2305
  • UFCW Local 555-Employers Health Trust: 1 (866) 796-7623

For member appeals, Zenith will send a copy of the written determination to the member and provider. The Appeals for members section of our Administrative Manual includes this information.

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